Though alternative payment models that prioritize quality over quantity have grown increasingly popular in many healthcare settings, similar progress has not been made in reforming reimbursements for prescription drugs. Dana Goldman and his colleagues Daniel M. Blumenthal and Anupam B. Jena suggest PCSK9 inhibitors are a perfect candidate for outcomes-based pricing contracts in a viewpoint in JAMA Cardiology.
PCSK9 inhibitors “provide an opportunity to use innovative reimbursement approaches to foster better accountability for patient outcomes,” they write. “Outcomes-based pricing represents a promising strategy for improving access to PCSK9 inhibitors at a price commensurate with their value to patients and the healthcare system.”
Outcomes-based pricing strategies are set between payers and pharmaceutical companies and involve using prospectively collected data on patients who have received the treatment to determine reimbursement amounts. Since reimbursements are based on individual patient outcomes, key parameter of this type of pricing strategy are the need for agreed upon outcomes that can be measured objectively and at a modest cost.
“We should structure outcomes-based agreements for PCSK9 inhibitors so that they protect payers from paying for a potential mortality benefit that never accrues. Conversely, they should reward pharmaceutical companies if the treatment ultimately reduces mortality rates,” explains the authors.
Given the uncertainty as well as the promise offered by innovative drugs like PCSK9 inhibitors, outcomes-based pricing might be an ideal strategy for managing financial risk while providing access to potentially lifesaving new therapies.
Read the full viewpoint in JAMA Cardiology.
Citation: Blumenthal, D. M., Goldman, D., & Jena, A. B. (2017). Tying reimbursement to outcomes is an ideal strategy for PCSK9 inhibitors. JAMA cardiology, 2(10), 1063-1064.