Value-Based Contracting Drops Co-Pays for Chronic Disease Drugs


Value-based contracts may also improve patient outcomes by increasing access to innovative medicines and supporting appropriate use.

Commercially insured individuals with health plans with value-based contracts for diabetes, high cholesterol, and HIV medicines had average co-pays that were 28% lower for those prescription medications compared with people on other plans, according to a report from the Pharmaceutical Research and Manufacturers of America (PhRMA).

Payers are exploring new contracts that connect reimbursement for medicines to the value for individual patients. Types of potential value-based contracts include performance-, outcomes-, indication-, and regimen-based contracts, among others.

“Results-based or value-based contracts can reduce healthcare system costs and can make medicines more affordable and accessible for patients,” Stephen J. Ubl, president and CEO of PhRMA, said in a press release. “The healthcare market is starting to move in this direction, but we need public policy reforms that allow greater flexibility for innovative payment arrangements that lower out-of-pocket costs and enable patients to access the right treatments the first time.”

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