Highmark recently said
its outcomes-based contract (OBC) with AstraZeneca showed positive results for
its commercial members with asthma and chronic obstructive pulmonary disease
(COPD) taking Symbicort — to the point where the drug manufacturer didn’t have
to pay back a rebate to the insurer.
Under Highmark's
year-long agreement with AstraZeneca, announced in April 2018, more than half
of its commercial members taking Symbicort (budesonide and formoterol fumarate
dihydrate) who had a primary diagnosis of asthma or COPD experienced stabilized
or improved symptoms, the insurer says.
Overall, Highmark's
involvement in OBCs is growing rapidly. The insurer "will have 15 [such]
contracts in place by January 2020 and we’re looking to do more," says
Kayse Reitmeyer, Pharm.D., Highmark's manager of pharmaceutical manufacturer
relations and rebate administration.
She explains that
Highmark "has moved on to different types of contract designs" for
OBCs, including medical outcomes-based agreements, where the manufacturer
offers a design centered around a drug's clinical trial results;
"persistency" or medication adherence-based agreements to track
whether members are continuing therapy; and total cost-of-care contracts that
track both pharmacy and medical spend.
To date, Highmark has
publicly disclosed two OBCs: a total cost-of-care design on Jardiance
(empagliflozin), marketed by Boehringer Ingelheim Pharmaceuticals, Inc., and
Eli Lilly and Co. for patients with diabetes; and a persistency and
adherence-based design on Takeda Pharmaceuticals America, Inc.'s Entyvio
(vedolizumab) for patients with irritable bowel syndrome, ulcerative colitis or
Crohn's disease, Reitmeyer says. Highmark expects to disclose two to three more
OBCs in the next few months "and share some Jardiance results soon,"
she says.
Looking ahead, Highmark
"will have a total cost-of-care contract in respiratory, tracking per
member per month [PMPM] or per member per year [PMPY], looking at all medical
and pharmacy costs in a certain drug class," Reitmeyer says.
As for Symbicort,
Highmark is in discussions with AstraZeneca about evolving that contract, she
adds.
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