When Amgen signed an outcomes-based reimbursement deal for its blockbuster rheumatoid arthritis drug Enbrel with Harvard Pilgrim Healthcare in 2017, it seemed like a strategy for preserving the market share of a product on the cusp of losing its patent protection. The patent threat has since been pushed off several years—but Amgen is still making concessions to insurers to preserve Enbrel’s favorable reimbursement status.
That became clear on Tuesday, when Amgen signed a deal with up-and-coming pharmacy benefits manager (PBM) Abarca that ties reimbursement for Enbrel to how it performs in patients. Specifically, Amgen agreed to issue rebates to Abarca’s clients for any patient with RA who stops using the drug after three months.
Abarca will be able to detect how patients are using Enbrel because the PBM has technology in place that allows it to track prescription behavior in real time, the company said in a statement. This is Amgen’s second outcomes-based contract with the PBM. Last year, the two companies agreed to tie reimbursement for Amgen’s cholesterol drug Repatha to outcomes, though they didn’t specify what those measures would be.
A spokesperson for Amgen didn’t provide a response to FiercePharma by press time.
Abarca CEO Jason Borschow said in the statement that Amgen’s “dedication to learning about how patients interact with their medications is admirable,” adding that the company has been “a great partner.”
For Amgen, any insight into why patients might decide not to stick with Enbrel will be important as the product faces competitive pressure. In the short term, that pressure will not be coming from biosimilars, thanks to an August ruling that’s keeping Sandoz’s copycat, Erelzi, off the market for now. But there are plenty of other rival RA treatments that could prove a threat to the $4.8-billion-a-year Enbrel.
The most immediate challenge to Enbrel’s market share is coming from biosimilars of other biologics to treat RA, including Johnson & Johnson’s Remicade and AbbVie’s best-selling Humira. The rise of those low-cost alternatives, particularly overseas, started to take a chunk of Enbrel’s market share last year, when the product posted an 8% sales decline.
Then there are the second-generation RA drugs, such as AbbVie’s Rinvoq and Pfizer’s Xeljanz, both of which are JAK inhibitors. They’ve run into some issues—there have been questions about safety and cost—but they are poised to draw at least some patients away from older choices like Enbrel.
During the most recent quarter, sales of Enbrel did increase 6% to $1.4 billion, but much of that growth was driven by price hikes, Amgen reported. The positive effect of the higher net selling price was dampened by a drop in unit sales, however.
Amgen’s outcomes deal with Abarca is structured differently than the Harvard Pilgrim contract was. In the earlier deal, Amgen agreed to pay less for Enbrel for any patient who scored below a certain threshold on six separate measurements. Those criteria included having to hike up the dose of Enbrel, needing a steroid in addition to it, or switching to a different product.
At the time, Amgen told FiercePharma that outcomes-based deals with payers were not a response to growing competition for its products, but rather a way to provide value to patients. Perhaps, but as one of the company’s most successful products loses ground to rivals, there’s little doubt its executives will be open to considering more payment plans that are tied to its performance.