Insurer ties drug payments to patient outcomes
Harvard Pilgrim Health Care on Monday announced deals with pharmaceutical companies that will allow the insurer to pay for drugs based on patient outcomes.
The contracts with Novartis and Eli Lilly come as many health plans, including the state's MassHealth program, are looking to move toward value-based payment models to help rein in costs.
"Executing these types of agreements can make it easier for payors to provide access to newer therapies since they tie payments to the drugs to meaningful endpoints," Harvard Pilgrim chief medical officer Michael Sherman said in a statement.
Under the deal with Novartis, Harvard Pilgrim will receive a discount on the new heart failure drug Entresto if the treatment does not reduce congestive heart failure hospitalizations by a set amount.
The health plan's agreement with Eli Lilly, over the type 2 diabetes drug Trulicity, allows it to "pay not for pills but for patient outcomes," Sherman said. Harvard Pilgrim will pay a lower net cost to the company if fewer members taking Trulicity reach a certain, favorable blood glucose level than members taking competing drugs. The cost will be higher if Trulicity patients do better than those on other medications.
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