As U.S. drug and healthcare costs climb upward, many market watchers have pointed to outcomes-based contracts as a promising way to put a check on the trend. Now, Boehringer Ingelheim and pharmacy benefit manager Prime Therapeutics are getting on board with the strategy to examine total healthcare costs for diabetes patients on Jardiance versus the competition.
Under the deal, Prime will tally pharmaceutical and medical claims for patients on the BI and Eli Lilly drug compared to patients on other diabetes medications. That way, according to a release from Prime, the PBM can "truly evaluate" how the SGLT2 drug stacks up against the competition in terms of outcomes and value.
Of course, it's far from the first outcomes-based contract as drug pricing and costs have become prominent issues in recent years. In launches for Kymriah and Luxturna, respectively, Novartis and Spark Therapeutics offered rebates if their pricey cell and gene therapies don't work. Novartis, which suffered a slow start for its heart failure medication Entresto, also entered performance-based pricing deals with Cigna and Aetna on the drug.
Around the industry in diabetes, Merck has a pay-for-performance deal with Aetna on Januvia, while Eli Lilly inked its own accord with Harvard Pilgrim for the weekly GLP-1 med Trulicity.
For its part, BI isn't the only diabetes drugmaker to have an outcomes-based deal with Prime. The PBM just last month entered into a pay-for-performance contract with Novo Nordisk on the type 2 diabetes drug Victoza. BI separately has another value-based contract for Jardiance with a national payer, a spokesperson told FiercePharma. That deal went into effect in late 2016.
In a recent PwC survey, many pharma executives said they see the potential benefits of value-based pricing, but many haven't personally entered such a deal. The PwC researchers wrote that those who've gotten involved have had an "outsized influence on trade industry messaging and new policy proposals."