- Merck & Co. has signed a deal with Aetna Inc. to link rebates for its diabetes drugs Januvia and Janumet to treatment outcomes among type 2 diabetes patients on the health insurer's commercial plans, the companies announced Tuesday.
- Merck will also participate in Aetna's predictive analytics-based wellness program, the first healthcare company to join the initiative. Aetna hopes the program will help identify patient populations and boost treatment adherence, initially in patients with diabetes located in Mid-Alantic markets.
- Together, Januvia (sitagliptin) and Janumet (sitagliptin/metformin) are Merck's best-selling drug franchise, pulling in a little over $6 billion in sales last year.
Value-based contracts for pharmaceuticals, once rare, have become more common in recent years. Payers in the U.S., always seeking to push back on high prices, have more frequently delayed coverage decisions on expensive new drugs until efficacy is further proven.
For drugmakers, on the other hand, pay-for-performance agreements can help boost uptake and secure all-important market share in new drug classes.
Novartis, for example, has signed value-based deals with Aetna, Cigna, Humana and Harvard Pilgrim for its new heart drug Entresto, part of an aggressive push to boost the medicine's fortunes after a disappointing launch. Not all the specifics are public for each deal, but each links Entresto's efficacy to either rebates or discounts on the price of the drug.
Cigna has also inked similarly styled deals with Amgen and the Sanofi/Regeneron team, tying the cost for each drugmaker's respective PCSK9 cholesterol drug to outcomes.
Overall payer interest in pay-for-performance appears to be high. A 2015 survey by Avalere, a healthcare consulting firm, found 63% of surveyed health plans "expressed high or very high interest" in outcomes-based deals for hepatitis C drugs. Oncology and rheumatoid arthritis were two other therapeutic areas of interest to those surveyed.
For Merck, the deal with Aetna could help sustain sales for its Januvia/Janumet franchise. While sales grew by 2% year-over-year in the second quarter, total prescription growth has fallen from levels seen in prior years.
At the same time, other drugs, such as Zetia, Vytorin and Cubicin, will soon face generic competition, raising the stakes for Merck's newer products. Maintaining high sales for Januvia could help Merck tread water as revenues from its star cancer drug Keytruda grow.