Merck's diabetes blockbuster Januvia boards pay-for-performance train with Aetna deal

Add Merck to the list of companies participating in pay-for-performance deals. Facing stepped-up competition in diabetes, the pharma signed a value-based contract with leading insurer Aetna on its blockbuster meds Januvia and Janumet.

Through the deal, the drugs’ effectiveness in managing Type 2 diabetes for Aetna’s patients will partially determine rebates.

For Januvia, the arrangement could provide a boost in the face of new launches in the GLP-1 and SGLT2 drug classes. The pact comes on the heels of a performance-based partnership between Eli Lilly & Co. and Harvard Pilgrim for the weekly GLP-1 med Trulicity.

So far, Januvia has weathered competition from Lilly and Boehringer Ingelheim's SGLT2 med Jardiance, which showed last year that it could cut cardiovascular risks, including heart attack and death. In second-quarter results, the Merck franchise brought in a consensus-beating $1.63 billion. But analysts still worry that the aging Januvia franchise may falter.

It's not just new rivalries that are heightening the strain on Januvia--and other diabetes meds, for that matter. They face increased pricing pressure from payers, too. Those pressures, along with rising drug costs for payers, have made drugmakers and insurers willing to test results-based setups. Apart from Eli Lilly, Merck joins companies including Novartis, Amgen, Regeneron and Sanofi to sign on with payers for performance-based plans.

Aetna has been active on the front, inking a deal with Novartis for the heart failure med Entresto. Under that deal, rebates depend on whether Entresto delivers real-world results similar to those in trials. Novartis inked a similar performance-based deal with Cigna.

Amgen, Regeneron and Sanofi each paired with payers for their next-gen cholesterol fighters in an effort to grow uptake. Amgen signed on with Harvard Pilgrim and Cigna with its Repatha, while Sanofi and Regeneron paired with Cigna on Praluent.

Along with the results-based Januvia deal, Aetna and Merck also unveiled AetnaCare, a “predictive analytics” platform to target wellness services toward individual patients. Merck will provide some of its previously developed educational resources and tools for the program.

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