US health insurance company Highmark has negotiated an outcomes-based pricing agreement for AstraZeneca’s respiratory drug, Symbicort. The inhaler is used to treat patients with asthma and chronic obstructive pulmonary disease (COPD) and improves airway function by decreasing inflammation in the lungs.
US patients who are insured by Highmark – including those in the payer’s core markets in Delaware, West Virginia and Pennsylvania – will be eligible for the new outcomes-based pricing. According to Highmark, their deal with AstraZeneca is one of the first in the pulmonary disease space.
“Highmark is committed to innovative contracting solutions that focus on clinical results and drive patients to products that will encourage better disease management. COPD continues to be one of the top spend therapeutic categories across our membership base,” said Dr. Ryan Cox, director of specialty pharmacy strategies at Highmark Inc. “By entering into outcomes-based agreements with pharmaceutical companies, we are helping to ensure that our members have access to products that provide better patient outcomes.”
Using medical data, Highmark will assess patients’ asthma or COPD-related symptoms to determine whether Symbicort is contributing to improved outcomes. If the inhaled drug doesn’t measure up to AstraZeneca’s clinical trial results, Highmark will receive a rebate on a portion of the cost of the drug.
“As a leader in innovative, value-based agreements, AstraZeneca recognizes the need to evolve towards a greater focus on value and shared accountability for patient outcomes. We have entered into value-based agreements across our therapeutic areas, and we are proud to stand behind the science of Symbicort in this agreement with Highmark,” said Rick R. Suarez, VP, Market Access, AstraZeneca US. “Our goal is to provide affordable access to AstraZeneca medicines for patients and this agreement honors our joint obligation to deliver better patient outcomes.”
Outcomes-based pricing models like this one have been touted as a potential way for payers to cope with the rising cost of prescription drugs. However, a recent study examining Amgen’s money-back guarantee for its cholesterol-lowering drug, Repatha, have criticized the model, claiming that it does little to improve the cost-effectiveness of the PCSK9 inhibitor.
“As an Integrated Delivery and Financing System, Highmark has the unique ability to be a pioneer in implementing these types of innovative contracts that can truly track the medical outcomes by leveraging our members’ integrated pharmacy and medical data,” said Cox. “As a result, our patients will be positioned to receive the most effective and efficient care that can improve their overall health.”
Over 11 million individuals in the US suffer from COPD, a condition which is the result of smoking in the majority of cases. With an incidence of one in 12, even more patients have asthma, and this number has risen by as much as 15 percent in the last 10 years.