Novo Nordisk tackles outcomes and affordability with pilot tying copays to adherence

Novo Nordisk
Novo Nordisk is working with Sempre Health on a pilot program that works with payers to reward patients for following treatment plans. (Novo Nordisk)

In a new approach to the pricing and payer issues beleaguering pharma in general and diabetes drugmakers in particular, Novo Nordisk has teamed up on a project that puts patients with diabetes to work earning drug discounts for good behavior.

The Danish drugmaker is working with Sempre Health on a pilot program that works through payers to offer patients discounts on their prescriptions, provided they reach particular goals.

Those goals include some familiar, apparently simple ones, such as filling prescriptions on time and taking drugs as prescribed. But as drugmakers and payers both know, getting patients to do so isn't simple at all. And in return, the program would offer patients incentives such as lower copays.

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And the appeal of Sempre’s system for Novo is not only that it includes outcome goals, but also that it works within the current system and works directly with payers, said Rich DeNunzio, the drugmaker's vice president of market access strategy and innovation.

"The platform that Sempre developed is one, in our mind, that is dynamic because it alters the benefit design, reducing the out-of-pocket cost for patients, while at the same time increasing adherence to drive down total cost of care,” he said.

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Sempre works with health plans to opt in to its system, and pharma company partners add their treatments to the program. It's working with other pharma companies along with Novo Nordisk, said Sempre CEO Anurati Mathur, although she was not permitted to name any others.

Health plans that opt in then choose which drugs to make available. If a plan selects Novo's diabetes meds, member patients automatically get the discount when they fill their prescriptions.

To help keep treatment on track, Sempre sends out texts with notes and reminders if patients opt in. Additional rewards for filling prescriptions on time, for instance, or continue refilling them over months, are determined by individual manufacturers.

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Data collected by Sempre in prevoius programs showed the system works. Mathur said its research found high opt-in rates—close to triple the average—and also resulted in high patient engagement and favorable lifts on adherence.

She said Sempre began as a way to help patients share in the healthcare savings they create when they take their meds as directed. The programs do that, she said, by “allowing patients to pay less when they take healthy actions. And I think is something that resonates right now with a lot of parties in healthcare.”

For Novo, another plus is that the Sempre program works well with the position it established around pricing in November 2016. As DeNunzio explained, the company has been working on innovating around three key pillars: transforming the complex pricing environment, creating more price predictability, and reducing patient costs, and this hits on the first and the last of those.