Search

Drugmakers Eating Costs? (Fat Chance)


DECEMBER 12, 2016 – THE LATEST PAY-FOR-PERFORMANCE ARRANGEMENTS BETWEEN BIG PHARMA AND PBMS ARE TIED TO EXCLUSIVE OR PREFERRED-PROVIDER STATUS. BUT HOW WILL THEY AFFECT YOUR EMPLOYEES?


A new type of pay-for-performance agreement (what a notion!) has insurers and self-funded employers wondering if all of a sudden Big Pharma is starting to play fair. Adam Rubenfire, writing for Crain’s Chicago Business, notes that “In most of these deals, insurers agree to offer reimbursement for a set price as long as the drugmaker agrees to pay a penalty if certain metrics aren’t met.”


“Payers say the deals give them assurance that they won’t be left holding the bag if a drug doesn’t deliver its promised medical benefit. Drugmakers are willing to go along because it helps get their products to more patients more quickly.” As such, the arrangements have become popular for drugs that treat conditions like diabetes, hepatitis C, and heart disease, where biomarkers can be used for benchmarking.


The author is quick to note, however, that drug manufacturers also like these new deals because they don’t have to compromise on the price of new drugs, which often come to market at significantly higher costs than older medications for the same condition. Of course, these arrangements are often tied to exclusive or preferred-provider status, meaning that older, more cost-effective alternatives could be sidelined.


Another fly in the ointment is non-adherence – if patients aren’t taking the drugs properly, everyone loses. Indeed, in order to facilitate these agreements, payers are using predictive modeling to determine which patients are most likely to be nonadherent and targeting those patients through mobile apps and other communications in order to remind them to take their medications.

Read the rest of Adam Rubenfire’s excellent article here: 

Would drug makers eat costs when their products don’t deliver?

Scripta_Insights_Logo_White.png

40 Grove St, Suite 270 Wellesley, MA 02482

CUSTOMER SUPPORT:

  • LinkedIn - White Circle
  • Facebook - White Circle
  • Twitter - White Circle
  • YouTube - White Circle

© Copyright 2020 Scripta Insights, Inc. 

Scripta™ is neither a pharmacy nor a doctor. The benefit service does not tell you what drug to take and does not participate in the drug selection process. Only your physician can determine the medications that are right for you. These alternative medications are options for less costly drugs that physicians may prescribe in place of the medications you are taking now. Scripta has reviewed your current medications only for the purpose of identifying potential cost savings for you to consider with your physician. Scripta has not analyzed the effectiveness or other therapeutic aspects of these medication alternatives. Accordingly, this report and any other forms of communication received from Scripta are not, nor should they be interpreted as, any form of treatment, drug regimen review, or provision of counseling or consultation by a prescriber, pharmacist or pharmacy. Do not stop taking your medication, change your medication, or start taking a new medication without being directed to do so by your physician and filling the prescription under the oversight of a licensed pharmacist. The alternatives set forth above may not be equivalent to your current medication, may interact adversely with your other medications, may not be indicated in light of your other conditions, may cause different or severe side effects, or may be less effective at treating your condition. Medication prices are approximate based on information provided by your pharmacy benefits manager, insurance plans, and/or employer, and may vary from pharmacy to pharmacy. Check with your insurance plan to obtain a full list of pharmacies where your prescriptions can be filled. All information herein is HIPAA protected, treated as highly confidential, and never shared with your employer.

Scripta™, Scripta Insights™ and The Best Meds at the Best Price® are registered trademarks of Scripta Insights, Inc. The contents of the site are for informational purposes only and not intended as a substitute for professional medical advice, diagnosis, or treatment. We do not recommend or endorse any specific prescription drug or pharmacy that may be mentioned herein. Reliance on any information provided by us, our affiliates, employees or others is solely at your own risk.