Highmark Health, a Pittsburgh-based Blues plan, has entered into a value-based drug-pricing contract with pharmaceutical company AstraZeneca for Symbicort, which is used to treat asthma and other chronic lung diseases.
Under the contract, Highmark said it will track whether the symptoms of its plan members using Symbicort are in line with the results of AstraZeneca's clinical trials. If the drug doesn't live up to its promise, AstraZeneca will provide Highmark with some savings.
Highmark didn't release specifics on the agreement's financial terms, but said the contract applies to commercial members in Pennsylvania, West Virginia and Delaware. Highmark said it expects the drug to perform well, meaning it doesn't plan to pocket any major savings from the drug-pricing agreement, which Highmark claims is the first involving prescription drugs that treat respiratory illnesses.
"Highmark is committed to innovative contracting solutions that focus on clinical results and drive patients to products that will encourage better disease management. COPD continues to be one of the top spend therapeutic categories across our membership base," Ryan Cox, Highmark's director of specialty pharmacy strategies, said in a statement.
Value-based drug agreements, in which insurers pay for the cost of a drug based on how effective it is, are uncommon, but more deals are popping up as insurers look for ways to get a handle on rising drug costs. Regulatory barriers and a healthcare system oriented to paying for care based on volume stand in the way of the deals becoming widespread.
The contracts also aren't easy to orchestrate. They take time and resources to mine immense amounts of data used to track outcomes. Even so, they're growing in prominence.
Highmark already has other outcomes-based contracts, including one in oncology, a spokeswoman said. Last year, Harvard Pilgrim CEO Eric Schultz said the insurer had 12 value-based drug-pricing contracts up and running. And national insurers including Aetna and Cigna Corp. have also touted the outcomes-based deals they have reached with drugmakers such as Novartis.
The spokeswoman for Highmark said the company expects to share more information about the agreement in early 2019.
The list price of Symbicort is often more than $300 for one inhaler of 120 doses, according to GoodRx. There are no generic alternatives.
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