Evaluating medical and pharmacy benefits can provide a better view of a medication's value.
As part of Prime Therapeutics’ CareCentered Contracting program, the pharmacy benefit manager (PBM) entered into an outcomes-based contracting agreement with Boehringer Ingelheim for empagliflozin (Jardiance) for the treatment of adults with type 2 diabetes, according to a press release.
Since Prime is owned by Blue Cross and Blue Shield, it is able to analyze medical and pharmacy claims to determine and manage the total cost of care. The PBM is able to assess each patient’s experience throughout their empagliflozin medication journey and compare that with the total cost of care for patients taking other diabetes drugs, according to the release.
“Because diabetes affects nearly 10% of the US population, Prime actively works to find solutions that can improve our members’ health outcomes and control the overall costs of diabetes,” said Jonathan Gavras, MD, chief medical officer at Prime. “Establishing a CareCentered Contracting agreement for Jardiance allows us to collect and analyze important data beyond pharmacy claims. These insights help drive the greatest value from the treatment.”
Due to its ability to gather data for both the medical and pharmacy benefits, Prime is able to evaluate the true cost of selected therapies and the effect on overall health care costs, according to the release.
“We’re pleased to enter into this outcomes-based contract with Prime, which represents an important step towards improving outcomes by lowering the total cost of care of people with diabetes,” said Christine Marsh, vice president, Market Access, Boehringer Ingelheim Pharmaceuticals, Inc. “Diabetes and cardiovascular disease put a significant financial burden on the healthcare system, and we are confident Jardiance may improve outcomes by reducing the overall healthcare costs of people with type 2 diabetes and cardiovascular disease.”
Prime noted that the comprehensive treatment of patients with diabetes is one of the PBM’s main focuses.
“While not the only approach we take to help ensure members are getting the value they deserve from the drugs they take, outcomes-based and/or value-based contracts are integral to our contracting strategy,” said Alec Mahmood, chief financial officer at Prime. “This contract, plus several others we’ve added in recent months, demonstrate Prime’s continued commitment to align manufacturers, members, payers and providers around the goal of improving health by helping to ensure drugs work as they are intended.”