UPMC Health Plan has recently entered into two value-based contracts for medications related to treating diabetes and opioid addiction.
There is growing interest in new and more progressive ways for payers and pharmaceutical manufacturers to create partnership contracts that connect a manufacturer’s reimbursement to the value that their pharmaceutical products deliver, according to one expert.
“Despite this growing interest, such contracts have been hindered by several barriers, including limited collaboration and consensus between prescribers and payers, difficulty measuring value-due to fragmented and limited data sets and lack of consensus on measures” says Chronis Manolis, RPh, chief pharmacy officer, UPMC Health Plan.
Despite these barriers, UPMC Health Plan has recently entered into two value-based contracts:
“In the case of Jardiance, previous contracts measured costs only in those with existing heart disease-this contract is unique in that it measures total cost of care,” Manolis says. “With Vivitrol, the goal of the contract is to align the incentives of the manufacturer with positive clinical outcomes among UPMC Health Plan members.”
The contracts change the paradigm around how drugs are paid for, according to Manolis. “Rather than the traditional approach of merely paying for the drug, we are now paying for results, which will encourage the insurer and the manufacturer to be on the same page-and that page is the health of the patient,” he says. “We are addressing the rising cost of medications and support more shared accountability and partnership with manufacturers, and greater value in pharmaceutical care.”
How it Came About
UPMC Health Plan established its new Center for Value-Based Pharmacy Initiatives (VBPI) last year to leverage a unique set of assets and resources at UPMC Insurance Services Division. The Center for Value-Based Pharmacy Initiatives, via contracts with various drug companies, aims to fundamentally change the way medications are paid for in the U.S.
Priorities for the VBPI include: