Cardiovascular disease patients covered under Harvard Pilgrim health plans will now be eligible for a full refund if they experience a cardiac event while taking Amgen’s cholesterol-lowering drug, Repatha. The drugmaker has offered a money-back guarantee on the PCSK9 inhibitor in the hopes that this could remove some barriers to payers’ coverage of the drug.
The full refund will be issued if a patient is hospitalized after experiencing a heart attack or stroke at least six months since they started taking Repatha. The insurer will only be able to recoup the cost of the drug if the patient has been relatively compliant to their medication schedule.
“Repatha has been shown to have a significant outcome on reducing cardiovascular morbidity for high risk individuals with elevated LDL cholesterol,” said Harvard Pilgrim Chief Medical Officer Michael Sherman. “However, there have been concerns raised about the cost of this new drug relative to existing statin treatments. We hope to negotiate more contracts of this type, in which a pharmaceutical company truly has ‘skin in the game’ going forward. This agreement is the first we have signed in which there is a full refund of all costs related to the medication if the patient experiences a heart attack or stroke while taking it.”
The deal is indicative of a change in the biopharmaceutical industry, where value-based pricing and outcomes-based insurance coverage are starting to become more common. This is the second time that health services company Harvard Pilgrim has signed an outcomes guarantee with Amgen for Repatha, setting a precedent for future promising therapies.
“As an organization, we are looking to pay for interventions that demonstrate value and are effective in treating serious illnesses, such as cardiovascular disease,” said Sherman. “That Amgen is willing to go at financial risk for patients with elevated LDL-C levels who are adherent to Repatha and suffer cardiovascular events shows that they are willing to stand by their data, and that sends a strong positive message to health plans, prescribing physicians and patients.”
While Repatha was shown to reduce the risk of cardiovascular events in the FOURIER clinical trial, the drug did not show a statically significant effect on patient death. As a result, sales of the drug have been slow, with total earnings reaching just over $140 million in 2016.
“Amgen is committed to combating cardiovascular disease, one of the largest public health concerns in the world, and our value-based partnership with Harvard Pilgrim further demonstrates our confidence in the significant value that Repatha can bring to patients, payers and society,” said Dr. Joshua J. Ofman, Senior vice president of Global Value, Access and Policy at Amgen. “Given the urgency to reduce LDL cholesterol in patients at high risk of cardiovascular events, we value our relationship with leading health plans like Harvard Pilgrim who have worked with us to refine their utilization management criteria to accelerate access for their high-risk patients. We look forward to partnering with other payers to create similar outcomes-based contracts for Repatha.”