Novartis signs on to value-based pricing for Entresto
Hospitalizations represent up to 80 percent of the direct medical costs of heart failure; reducing heart failure hospitalizations can help bring down overall healthcare costs.
Cigna and Aetna Inc. have come to an agreement with Novartis for a performance-based price for its heart failure drug, Entresto.
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Entresto, a tablet taken twice daily, is in a new class of medication calledangiotensin receptor neprilysin inhibitor (ARNI). The FDA views Entresto as containing the neprilysin inhibitor, sacubitril, which is a new molecular entity, and the angiotensin receptor blocker (ARB) valsartan. It was approved for heart failure patients with reduced ejection fraction (HFrEF) based on the PARADIGM-HF trial.
“The agreements use heart failure hospitalization as an outcome measure, based on the FDA-approved label,” says Michael Billings, Novartis spokesperson. “Novartis will reduce the price of Entresto to payers, if the rate of heart failure hospitalization of patients on Entresto exceed a pre-specified threshold.”
Vogenberg
“Outcome or performance-based contracting continues to gain traction even though we remain in a transitional marketplace that is generally chaotic across all stakeholders,” according to Randy Vogenberg, PhD, partner, Access Market Intelligence, and cofounder National Institute of Collaborative Healthcare, Greenville, S.C.
“Health plans as well as PBMs remain focused on clinically driven outcomes that may work in some insurance segments but not necessarily all,” he says. “The risk being leveraged in such contracting remains focused on the cost of drug.”
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“Patients need access to innovative medicines, and we are committed to doing our part,” says Billings. “Outcomes-based contracting models are a potentially promising way to support access while demonstrating the real-world benefits of innovative medicines. We believe these agreements are good news for patients.”
Because Entresto will have preferred-formulary tier status, patients in these plans will likely have reduced out-of-pocket costs for Entresto, according to Billings.
In the largest clinical trial ever conducted in heart failure, PARADIGM-HF, Entresto demonstrated superiority to ACE-inhibitor enalapril, reducing the risk of heart failure hospitalization or cardiovascular death by 20%.
A post-hoc analysis revealed that Entresto substantially reduced 30-day hospital readmissions compared to enalapril among heart failure patients with HFrEF. For the analysis, presented at the American Heart Association’s Scientific Sessions in November 2015, researchers assessed the rate of hospital readmission for any cause following a hospitalization for heart failure in the PARADIGM-HF trial. They found that 44% fewer patients treated with Entresto were readmitted for heart failure, and 36% fewer patients were readmitted for any cause, within 30 days following a heart failure hospitalization compared to those on enalapril.
“The significance is that this may correlate with improved patient prognosis and lower costs to the healthcare system, thus helping to reduce the health and economic burden associated with this condition,” according to Billings.
Heart failure accounts for more than 1 million hospitalizations in the U.S. each year, according to a recent American Heart Association