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Can Outcomes-Based Pharmaceutical Contracts Reduce Drug Prices in the US? A Mixed Methods Assessment

Published online by Cambridge University Press:  01 January 2021

Elizabeth Seeley ,
Susan Chimonas  and
Aaron S. Kesselheim
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Abstract

To improve the value of pharmaceutical spending, some manufacturers and payers have introduced outcomes-based contracts, where rebates are tied to specified outcomes. We reviewed the literature and interviewed key experts to assess these contracts' potential to slow pharmaceutical spending. We found that while outcomes-based contracts are increasingly common in the US, they are still limited by multiple factors — including the lack of meaningful outcomes data. Moreover, there is no evidence to date that they slow pharmaceutical spending or increase access. Experts favored having CMS test and rigorously evaluate this model to achieve a better understanding of the implications.

Type
Independent Articles
Information
Journal of Law, Medicine & Ethics , Volume 46 , Issue 4: Next Steps in Health Reform , Winter 2018 , pp. 952 - 963
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

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References

Claxton, G., Levitt, L., Long, M., and Blumenkranz, E., “Increases in Cost-Sharing Payments Have Far Outpaced Wage Growth,” Peterson-Kaiser Health System Tracker, October 4, 2017, available at <https://www.healthsystemtracker.org/brief/increases-in-cost-sharing-payments-have-far-outpaced-wage-growth/?post_types=brief#item-start> (last visited November 9, 2018).+(last+visited+November+9,+2018).>Google Scholar
The Centers for Medicare and Medicaid, “What are the Value-Based Programs?” available at <https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html> (last visited November 9, 2018).+(last+visited+November+9,+2018).>Google Scholar
Kesselheim, A. S., Avorn, J., and Sarpatwari, A., “The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform,” JAMA 316, no 8 (2016): 858–871.Google Scholar
Staton, T., “Amgen Scores PCSK9 Exclusive in Pay-for-Performance Deal with Harvard Pilgrim,” FiercePharma, November 9, 2015, available at <https://www.fiercepharma.com/sales-and-marketing/amgen-scores-pcsk9-exclusive-pay-for-performance-deal-harvard-pilgrim> (last visited November 9, 2017); T. Staton, “Cigna Inks Results-Based Deals on Pricey Amgen, Sanofi PCSK9 meds,” FiercePharma, May 11, 2016, available at <https://www.fiercepharma.com/pharma/cigna-inks-results-based-deals-pricey-amgen-sanofi-pcsk9-meds> (last visited November 9, 2018).+(last+visited+November+9,+2017);+T.+Staton,+“Cigna+Inks+Results-Based+Deals+on+Pricey+Amgen,+Sanofi+PCSK9+meds,”+FiercePharma,+May+11,+2016,+available+at++(last+visited+November+9,+2018).>Google Scholar
Sagonowsky, E., “Amgen puts Repatha Outcomes Data to Work in Refund Deal with Harvard Pilgrim,” FiercePharma, May 3, 2017, available at <https://www.fiercepharma.com/pharma/amgen-inks-repatha-refund-arrangement-harvard-pilgrim> (last visited November 9, 2018).+(last+visited+November+9,+2018).>Google Scholar
Staton, T., “It's Not Just Payers Holding Back on PCSK9 Outcomes Data. Doctors are Holding Back Too,” FiercePharma, February 16, 2016, available at <https://www.fiercepharma.com/sales-and-marketing/it-s-not-just-payers-waiting-on-pcsk9-outcomes-data-doctors-are-holding-back> (last visited November 9, 2018). (last visited November 9, 2018).' href=https://scholar.google.com/scholar?q=Staton,+T.,+“It's+Not+Just+Payers+Holding+Back+on+PCSK9+Outcomes+Data.+Doctors+are+Holding+Back+Too,”+FiercePharma,+February+16,+2016,+available+at++(last+visited+November+9,+2018).>Google Scholar
Garrison, L. et al., “Private Sector Risk-Sharing Agreements in the United States: Trends, Barriers, and Prospects,” American Journal of Managed Care 21, no. 9 (2015): 632–640.Google Scholar
Choe, S. and Learch, C., “Health Plans Are Actively Exploring Outcomes-Based Contracts,” Avalere Health, May 30, 2017, available at <http://avalere.com/expertise/life-sciences/insights/health-plans-are-actively-exploring-outcomes-based-contracts> (last visited November 9, 2018).+(last+visited+November+9,+2018).>Google Scholar
Miles, M.B. and Huberman, A.M., Qualitative Data Analysis: An Expanded Sourcebook (Thousand Oaks, CA: Sage Publications, 1994).Google Scholar
Crabtree, B.F. and Miller, W.L., Doing Qaualitative Research (Thousand Oaks, CA: Sage Publications, 1999).Google Scholar
Constas, M.A., “Qualitative Data Analysis as a Public Event: The Documentation of Category Development Procedures,” American Educational Research Journal 29, no. 2 (1992): 253–266.Google Scholar
Bradley, E.H., Holmboe, E.S., et al., “A Qualitative Study of Increasing Beta-Blocker Use after Myocardial Infarction: Why do Some Hospitals Succeed?” JAMA 285, no. 20 (2001): 2604–2611.Google Scholar
QDA Miner Lite, Qualitative Text Analysis Software, available at <https://provalisresearch.com/products/qualitative-data-analysis-software/freeware/> (last visited November 9, 2018).+(last+visited+November+9,+2018).>Google Scholar
See above Garrison et al., supra note 7; Choe, S., Learch, C., “Health Plans Are Actively Exploring Outcomes-Based Contracts,” Avalere Health, May 30, 2017, available at <http://avalere.com/expertise/life-sciences/insights/health-plans-are-actively-exploring-outcomes-based-contracts> (last visited November 9, 2018); A. Sexton Ward et al., “Regulatory, Legal Uncertainties Are Barriers to Value-Based Agreements for Drugs,” Health Affairs Blog, November 4, 2016, available at <https://www.healthaffairs.org/do/10.1377/hblog20161104.057443/full/> (last visited November 9, 2018); P. Keckley, “Value-Based Pricing for Pharmaceuticals: Implications of the Shift From Volume to Value,” Deloitte Issue Brief, 2012, available at <http://deloitte.wsj.com/cfo/files/2012/09/ValueBasedPricingPharma.pdf> (last visited November 9, 2018); P. Neuman, “Risk-Sharing Arrangements that Link Payment for Drugs to Health Outcomes Are Proving Harvard to Implement,” Health Affairs 30, no. 12 (2011): 2329–2337.+(last+visited+November+9,+2018);+A.+Sexton+Ward+et+al.,+“Regulatory,+Legal+Uncertainties+Are+Barriers+to+Value-Based+Agreements+for+Drugs,”+Health+Affairs+Blog,+November+4,+2016,+available+at++(last+visited+November+9,+2018);+P.+Keckley,+“Value-Based+Pricing+for+Pharmaceuticals:+Implications+of+the+Shift+From+Volume+to+Value,”+Deloitte+Issue+Brief,+2012,+available+at++(last+visited+November+9,+2018);+P.+Neuman,+“Risk-Sharing+Arrangements+that+Link+Payment+for+Drugs+to+Health+Outcomes+Are+Proving+Harvard+to+Implement,”+Health+Affairs+30,+no.+12+(2011):+2329–2337.>Google Scholar
See Garrison et al., supra note 7.Google Scholar
Eli Lily and Company and Anthem, Promoting Value Based Payment Arrangements, January 29, 2016, available at <https://lillypad.lilly.com/WP/wp-content/uploads/LillyAnthemWP2.pdf> (last visited November 9, 2018); See Sexton Ward et al., supra note 14.+(last+visited+November+9,+2018);+See+Sexton+Ward+et+al.,+supra+note+14.>Google Scholar
The Cost of Prescription Drugs: How the Drug Delivery System Affects What Patients Pay, Full Committee Hearing to the US Senate Committee on Health, Education Labor and Pensions, June 13, 2017, available at <https://www.help.senate.gov/hearings/the-cost-of-prescription-drugs-how-the-drug-delivery-system-affects-what-patients-pay> (last visited November 9, 2018).+(last+visited+November+9,+2018).>Google Scholar
Seeley, E. and Kesselheim, A., “Outcomes-Based Pharmaceutical Contracts: An Answer to High Drug Spending?” Commonwealth Fund Issue Brief, September 27, 2017, available at <https://www.commonwealthfund.org/publications/issue-briefs/2017/sep/outcomes-based-pharmaceutical-contracts-answer-high-us-drug> (last visited December 11, 2018).+(last+visited+December+11,+2018).>Google Scholar
Centers for Medicare and Medicaid, available at <https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-12.html> (last visited November 9, 2018).+(last+visited+November+9,+2018).>Google Scholar
Concerns with Rebates in the Medicare Part D program, Department of Health and Human Services OIG report, March 2011, available at <https://oig.hhs.gov/oei/reports/oei-02-08-00050.pdf> (last visited November 9, 2018).+(last+visited+November+9,+2018).>Google Scholar
Marsden, G. and Towse, A., “Pearson S. Gene Therapy: Understanding the Science, Assessing the Evidence, and Paying for Value. A Report from ICER and OHE,” March 2017, available at <https://icer-review.org/wp-content/uploads/2017/03/ICER-Gene-Therapy-White-Paper-030317.pdf> (last visited November 9, 2018); T Beaton, “Outcomes-Based Contracts Offer Payers New Pharmaceutical Options,” HealthPayer Intelligence, January 2018, available at <https://healthpayer-intelligence.com/news/outcomes-based-contracts-offer-payers-new-pharmaceutical-options> (last visited November 9, 2018).+(last+visited+November+9,+2018);+T+Beaton,+“Outcomes-Based+Contracts+Offer+Payers+New+Pharmaceutical+Options,”+HealthPayer+Intelligence,+January+2018,+available+at++(last+visited+November+9,+2018).>Google Scholar
Sagonowsky, E., “Spark Sets off Gene Therapy Debate with $850K Sticker on Luxturna,” FiercePharma, January 2018, available at <https://www.fiercepharma.com/pharma/spark-prices-gene-therapy-luxturna-at-850k-grabbing-top-spot-pharma-s-costliest-drugs> (last visited November 9, 2018); Harvard Pilgrim Healthcare news, “Harvard Pilgrim is the First Health Plan to Directly Negotiate Outcomes-Based Agreement for Groundbreaking Gene Therapy,” January 3, 2018, available at <https://www.harvardpilgrim.org/public/news-detail?nt=HPH_News_C&nid=1471914707173> (last visited November 9, 2018).+(last+visited+November+9,+2018);+Harvard+Pilgrim+Healthcare+news,+“Harvard+Pilgrim+is+the+First+Health+Plan+to+Directly+Negotiate+Outcomes-Based+Agreement+for+Groundbreaking+Gene+Therapy,”+January+3,+2018,+available+at++(last+visited+November+9,+2018).>Google Scholar