On the Horizon-Performance-Based Contracts for Drugs?--May 2009
Should health insurers reimburse for prescription drugs based on how well they work? That is the theory being tested in 2 new programs that will link medication pricing for leading diabetes and osteoporosis medications to patient results.
Cigna Corp recently entered into an agreement with Merck & Co, maker of the oral antidiabetes medications sitagliptin (Januvia) and sitagliptin/metformin (Janumet), whereby Cigna will review available A1C lab values for patients taking any oral antidiabetic medications; if, at the end of the year, A1C values have improved, the discounts Merck offers on the 2 drugs will increase.
In an effort to improve medication adherence, Cigna also will review claims data for its plan participants on Januvia or Janumet to determine if these patients are taking the medications as prescribed by their physicians. If they are, Merck will increase the discounts it offers on these medications even more. Both companies agreed that aligning incentives behind improving patient health is one of the most effective ways to achieve long-term health improvement.
More evidence of this trend can be found in a pilot Fracture Protection Program under the auspices of Health Alliance Medical Plans and the Alliance for Better Bone Health. Through the program, the Alliance for Better Bone Health (Procter & Gamble Pharmaceuticals and sanofi-aventis) will help offset equivalent costs of a covered nonspinal fracture for eligible Health Alliance members correctly taking the once-a-month osteoporosis pill risedronate sodium (Actonel) prior to the fracture. The pilot program could lower insurance costs for Health Alliance, which in turn, could be passed along to subscribers in the future.
"The Alliance for Better Bone Health is backing up the efficacy of Actonel to help prevent nonspinal fractures with a concept that has been talked about for years but few have ever executed," noted Jeff Ingrum, Health Alliance chief executive officer.
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