- Harvard Pilgrim Health Care Inc. will pay less for AstraZeneca plc's asthma drug Symbicort if its members experience worsening symptoms beyond a predetermined level set by an outcomes-based contract the two companies announced on April 18.
- Under the agreement, Harvard Pilgrim will monitor asthma-related symptoms for members taking Symbicort and compare their experience to the clinical trial results reported by AstraZeneca for the combination anti-inflammatory medicine.
- It's the third outcomes-based deal the New England-based insurer has inked with the pharma, adding to previous agreements covering Brilinta and Bydureon.
Correction: A previous version of this article misidentified the disease Eli Lilly & Co.'s Forteo is approved to treat.
Harvard Pilgrim has been one of the most active companies testing whether outcomes-based contracts can better align payment with the value actually experienced by patients.
To date, the insurer has publicly announced nine such deals with pharma companies, including Eli Lilly & Co., Amgen Inc. and Novartis AG, in addition to AstraZeneca.
"We believe that outcomes and value-based contracts are one way to begin to address the need for greater focus on value in our health system," said Michael Sherman, Harvard Pilgrim's chief medical officer, in an April 18 statement.
For insurers, outcomes-based contracts can be a tool to extract further price discounts if a drugmaker's medicine fails to live up to clinical expectations. Most agreements center on either older drugs facing increased competition or new entrants that haven't fully gained traction on the market. Think Eli Lilly's osteoporosis medication Forteo (teriparatide) or Amgen's cholesterol drug Repatha (evolocumab).
Yet these types of deals are also touted as a potential solution to the sky-high prices — and real clinical promise — of cell and gene therapies.
In that vein, Harvard Pilgrim reached an agreement in principle with Spark Therapeutics Inc. to base pricing for the biotech's gene therapy Luxturna (voretigene neparvovec-rzyl) on patient outcomes.
The deals face skeptics, though. Pharma groups have pushed these deals as a solution to pricing concerns, yet drugmakers are generally unwilling to lower list prices from the beginning — inviting criticism that greater rebating around "value" will simply line the pockets of insurers and pharmacy benefit managers.
A study published in the Annals of Internal Medicine earlier this month, for example, found Amgen's offer of a refund for Repatha in certain circumstances to be largely meaningless from a cost-effectiveness standpoint.
Drugmakers and insurers appear increasingly willing to test building outcomes measures into contracts. Whether they'll make a difference for patients and the system as a whole remains unclear.