Under a value-based contracting agreement believed to be the
first of its kind, UPMC Health Plan will receive discounts for two Biogen Inc.
multiple sclerosis (MS) drugs — Tecfidera (dimethyl fumarate) and Avonex
(interferon beta-1a) — based on patient-reported measures of disability
progression. The agreement is also based on research with a panel of key MS
stakeholders who identified the most meaningful outcomes in relapsing forms of
MS.
UPMC's Center for Value-Based Pharmacy Initiatives led the
research and developed the value-based contract.
Previous value-based contracts for MS drugs have connected
payment to outcome indicators derived from claims and electronic health record
data, says Rochelle Henderson, Ph.D., Express Scripts' vice president of research
and a co-author of the study report.
"This research [gives] a greater level of transparency into
the outcome indicators that rank the highest in terms of value for
stakeholders," she says. "The key advantage of patient-reported
outcomes is that it gets at information that can be used to evaluate the
success of a medication where that information is not available by traditional
means."
Similarly, Henderson says, many outcomes that are important to
payers are not available in the electronic medical record. "What we
learned is that stakeholders rated 'worsening physical disability' and
'functional impairment' as the most valuable indicators for providing
information about the status of MS."
Payer interest and participation in outcomes-based contracting
with manufacturers continues to grow. "Based on our research and our
discussions with stakeholders in health care, there are a number of
organizations on the payer side who would like to go in this direction,"
says Avalere Health's John E. Linnehan, practice director of health economics
and advanced analytics.
"Payers typically are looking for outcomes-based
contracting in conditions with high prevalence, high costs, or both,"
Linnehan says, adding that because the MS category includes new entrants and
generics, it is a focus of interest for outcomes-based contracts.
From
RADAR on Drug Benefits
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