Performance-Based Risk-Sharing Arrangements for Pharmaceutical Products in the United States: A Systematic Review

Abstract

No funding supported this systematic review. Yu is an employee and shareholder of Allergan. Chin reports personal fees from Formulary Resources. Oh and Farias have nothing to disclose. Study concept and design were primarily contributed by Yu, along with the other authors. All authors contributed to the collection and interpretation of the data. The manuscript was written by Yu, Chin, Oh, and Farias and revised by Yu and Chin, along with the other authors.

Identifying Outcome Measures for Coronary Artery Disease Value-Based Contracting Using the Delphi Method

“…Heart attack, stroke, and cardiovascular death, as well as major and minor bleeding events, are endpoints typically used in modern clinical trials for antiplatelet therapy [ 13 , 14 ]. While it is unclear how previous value-based contracts for antiplatelet medications selected their outcomes, their foci on the incidence of heart attacks and hospitalizations due to cardiovascular events suggest the perceived value of these indicators in assessing drug effectiveness in a manner that is feasible to collect through administrative claims data [ 5 – 7 ]. Our finding that “preventing heart attacks” ranks as the most meaningful outcome among our diverse stakeholder group verifies and supports the utility of this measure in future value-based contracts for CAD medications.…”

“…There have been three publicly disclosed value-based contracts for antiplatelet medications in the United States to date [ 4 ]. Two of the three base drug pricing on reduced hospitalizations due to cardiovascular events, while the third ensures shared coverage of treatment costs if the rate of heart attacks in patients taking the antiplatelet exceeds a certain threshold [ 5 – 7 ]. It is unclear how these outcome measures were chosen, and whether they are meaningful to all stakeholders affected by value-based contracts.…”

Performance-Based Risk-Sharing Arrangements (PBRSA): Is it a Solution to Increase Bang for the Buck for Pharmaceutical Reimbursement Strategy for Our Nation and Around the World?

“…What is the justification for allowing this cholesterol-lowering drug to be in the formulary? Payers can align payments for drugs with "value" they create based on their willingness-to-pay, while drug manufacturers in turn will receive incentives to continue developing new treatments [2]. Amgen's PCSK-9 inhibitor, evolocumab, entered into a PBRSA in 2016 with Cigna.…”

“…The contract included additional discounts if the utilization of the drug exceeds agreed levels. Amgen also agreed to an adherence provision that conditions discounts on patients reliably taking the drug [2]. Harvard Pilgrim has entered into a second contract with Amgen in 2017 that guarantees the health plan and its members will receive a full refund of drug costs if a member is hospitalized for a myocardial infarction or stroke after taking evolocumab for 6 months or more and maintaining an appropriate level of drug compliance [20].…”

Innovación tecnológica y financiación de prestaciones

“…Los primeros ejemplos incluyeron tratamientos para la esquizofrenia y las estatinas, fundamentalmente aplicados en los países anglosajones. La crisis económica de la década pasada potenció el interés de muchos otros países en estos acuerdos (Piatkiewicz, Traulsen y Holm-Larsen, 2018), que se han centrado especialmente en el ámbito de los medicamentos biológicos, las terapias dirigidas y las enfermedades infecciosas, raras o autoinmunes (Ferrario et al, 2017;Yu et al, 2017).…”