- U.S. health plans are eager to enter into outcomes-based contracts with drug companies, especially in hepatitis C and oncology, according to a survey conducted by Avalere, a healthcare consulting firm.
- Among surveyed companies, 63% of health plans had a high, or very high, level of interest in pay-for-performance deals for hep C or cancer drugs, perhaps reflective of the high cost of those treatments.
- Interest in these types of contracts has grown in recent years, and several U.S. insurers have recently signed deals with big pharma companies for new heart failure and cholesterol drugs.
Within the last several months, several high-profile pay-for-performance deals have been negotiated between payers and drug makers. In February, both Aetna and Cigna negotiated deals with Novartis for its new heart-failure medication, Entresto. And in May, Cigna signed agreements with Amgen and the team of Sanofi/Regeneron to link the cost of respective PCSK9 cholesterol drugs to patient outcomes.
Express Scripts, the largest pharmacy benefits manager in the U.S., has also been aggressive on this front and recently said that it would implement indication-based pricing later this year.
Outcomes-based deals offer a mechanism to contain costs while maintaining broad patient access.
“The growth of outcomes-based contracts between plans and manufacturers is a clear response to the health system’s call for cost-containment without restricting patients’ access to new, breakthrough therapies,” said Dan Mendelson, president at Avalere.