Drug Companies Ask Plans To Just Say 'Yes' to Risk.

about its effectiveness will have to be high, and payers will need to be concerned about inappropriate use. Their four-year-old analysis of the factors needed for risk-sharing arrangements to succeed still rings true. Earlier this year, Aetna and Cigna signed deals with Novartis that link payments for its new heart failure medication, a valsartan–sacubitril combination (Entresto), to the hospitalization rates of people on the medication. Entresto’s list price is $4,500 per year, and it is up against inexpensive medications for heart failure with long track records. There are a number of criteria that can be considered for outcomes-based pharma contracts that align pricing with value, according to Christopher Bradbury, senior vice president of integrated clinical and specialty drug solutions for Cigna Pharmacy Management. “Criteria to look at can include: significant spend in the drug class; expensive drugs; the existence of therapeutic alternatives—as these agreements can create additional competition beyond getting an excellent unit price; and an agreed upon outcome metric that can be measured and is valued,” Bradbury says. Robert Dubois, MD, executive vice president of the National Pharmaceutical Council, a research organization funded by the pharmaceutical manufacturers, says that, “One reason manufacturers were historically interested in risk agreements was to differentiate their product from others in drug classes where there are similar agents in terms of mechanism of action and clinical results. An emerging reason to consider risk-sharing agreements is to address the growing concern about the price, expenditures, and value of pharmaceuticals in new payment models.”