December 12, 2016
The latest wrinkle in the fight against rising drug prices involves insurers and pharmacy benefit managers asking drugmakers to accept lower prices for the latest medicines emerging from their labs when they don't achieve the desired results.
In most of the deals, insurers agree to offer reimbursement for a drug at a set price as long as the drugmaker agrees to pay a penalty if certain metrics aren't met. Drugs for combating diabetes, hepatitis C and heart disease are prime targets for the new pricing arrangements, where biomarkers like cholesterol, blood glucose or virus eradication can be used as measurable benchmarks.
Although Express Scripts, the nation's largest PBM, has been able to negotiate discounts, hesitance to substantially lower drug prices is one of the biggest reasons why manufacturers are increasingly interested in engaging in outcome-based deals, said IHPI member Mark Fendrick, director of the Center for Value-Based Insurance Design at U-M. In most of these deals, they don't take a hit on price if the drug works as it should.