VBAs Between Pharmaceutical Manufacturers and Payers

Goals

To provide available information on Value Based Contracts/Agreements between pharmaceutical manufacturers and payers in the US, since August,2018.

Early Findings

Early Findings

Insights Regarding Luxturna’s VBAs

  • As published on March 23, 2019, Spark Therapeutics has signed a deal with Harvard Pilgrim that links payment for Luxturna—for patients with confirmed biallelic RPE65 mutation-associated retinal dystrophy—to both short-term efficacy within 90 days and longer-term durability at 30 months.
  • The same article cited above also mentioned that Spark was in talks with the CMS about a long-term payment demonstration for Medicare and Medicaid patients, tying 50% of the price of Luxturna to efficacy and durability over three to five years.

Insights Regarding Zolgensma’s VBAs

  • In June 2019,Steven D. Pearson, M.D., ICER was quoted saying . “Insurers were going to cover Zolgensma no matter the price, and Novartis has spoken publicly about considering prices that approached $5 million. It is a positive outcome for patients and the entire health system that Novartis instead chose to price Zolgensma at a level that more fairly aligns with the benefits for these children and their families.”
  • In a statement published in May 2019, Michael Sherman, chief medical officer of health plan Harvard Pilgrim Health Care, declared the price of Novartis’ Zolgensma to be “fair.”
  • Sherman also mentioned cutting a deal with Novartis “to get some money back if Zolgensma proves ineffective.” However, these Value-Based Agreements had to obey certain pricing rules of the Medicaid health-insurance program for pediatric drugs.

Insights Regarding Other Eyecare VBAs

  • As updated in April 2019, Pilgrim Health Care had signed numerous value-based contracts with pharmaceutical companies – namely AstraZeneca, Spark Therapeutics, Amgen, Eli Lilly & Company, Novartis for drugs that treated conditions such as asthma, chronic obstructive pulmonary disease (COPD), retinal dystrophy, LDL cholesterol, acute coronary disease, type II diabetes, rheumatoid arthritis, osteoporosis and heart failure.
  • As published on June 13, 2019 Vantage EyeCare, LLC announced its strategic alliance with Tandigm Health, a population health services organization that was extending its value-based model beyond its 420 primary care physicians to more than 300 specialists.
  • As published on July 18, 2019 Southern New England Practice Transformation Network (SNE-PTN) awarded over 1,100 select Vision Source® member practices achievement payments of up to $2,500 per practice, for their performance in the transformation towards value-based care, in 2019.

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