Health insurer Cigna Corp. has announced it has negotiated a value-based contract for Praluent, a new cholesterol-lowering drug belonging to a the class of PCSK9 inhibitors. Praluent, is co-marketed by Sanofi SA and Regeneron Pharmaceuticals Inc.
The drug costs at least $14,000 a year, and Cigna negotiated an undisclosed discount off the list price.
If Cigna-insured patients who take the drugs aren’t able to reduce LDL cholesterol at least as well as what was shown in clinical trials, the manufacturers will further discount the costs of the drugs—and not just for patients who didn’t meet the cholesterol goals. If the drugs meet or exceed expectations, the original negotiated price stays, according to Cigna.
This is viewed as a significant step in a broader push to tie the cost of drugs to how well they work.
Outcome-based healthcare requires moving from broad DTC campaigns that create demand from new consumers, to programs that attract the right consumers, and support and measure how well they do while using your drugs.
Rob Rebak, Chairman and CEO of QualityHealth was one of the first executives to identify the need for this fundamental shift – way back in 2012 (DTC Perspectives).
It is now clear that outcomes-based healthcare is here to stay and with it comes the need to measure how well drugs perform. The change requires thinking differently, learning new skills and working with different types of vendors.
Four Critical Success Factors for Outcome-Based Marketing
In contrast to traditional DTC, outcomes-based marketers will have to:
a) Start with a far narrower aperture, to target and convert only the right (i.e., better qualified) consumers
b) Deliver effective, all-rounded, end-to-end patient programs to ensure that patients fill their prescriptions, take them as directed, and stay on medications as long as medically needed
c) Measure, adhere to and be governed this new performance metric in marketing: real-world clinical benefit data
d) Embrace a new business model, with marketing supplier contracts executed on the basis of how well consumers do on drug
Those that embrace outcomes-based marketing will not only create wins for their brand, but will have a more rewarding and secure career. Do take the time to read Rob’s full article @ The Digital Pharma Blog.
How Outcomes-based Marketing is Different
A CareFlow maps a patient’s journey from the first awareness of a problem to treatment,
examining the factors guiding their decisions at each stage. These insights enable pharma
marketers to engage with patients in ways that feel natural and personal. That may mean
providing information to help an important choice to be made, supporting the execution of that
choice, or simply empathizing.
Supporting CareFlows requires a reallocation of marketing focus and investment in digital enabling technology. @How pharma companies can better understand patients.
Beginning as early as January 2017, the agency will be seeking “risk-sharing” deals with pharmaceutical manufacturers to link drug payments with patient outcomes. @ CMS.gov
CMS’s surprise announcement was soon followed by a report from the Department of Health and Human Services, “Observations on Trends in Prescription Drug Spending”. The report turns the spotlight on the shift toward more expensive prescriptions—rather than changes in the total quantity of prescriptions. @ HHS.
Novartis has entered a performance-based pricing pact with U.S. health insurance majors Cigna and Aetna for Entresto, its new congestive heart failure drug.
The novel deal crafts payment schemes based on patient outcomes and comes as drug companies are under pressure to lower prices. Cigna says the deal ties the price of Entresto to how well it improves the health of patients relative to its performance in clinical trials. @ Drug Discovery & Development
The High-Touch Challenge
While specialty drugs have been available for several decades, the rapid growth in both the quantity and cost of these drugs over the last few years has put specialty drug therapies in the spotlight.
As specialty drugs increase in prevalence, the specialty pharmacy may turn out to be at the very center of the accountable care movement. New reimbursement models tied to improving outcomes are emerging, and these may help to offset the continual decline in pharmacy margins.
However, accountable care organizations and insurers focused on the cost and performance of specialty drugs expect pharmacies to deliver high-touch services that deliver positive outcomes. While many specialty pharmacies are eager to attract new business, providing cost-effective services that meet increased expectations for patient care is a challenge.
The health care industry is in the midst of dramatic change, forcing healthcare providers to reevaluate their strategies, business models and capabilities. These shifts require healthcare providers to compete for and engage with patients in very different ways, creating an innovation imperative. @AVIA