Drugmakers are coming up with new, experimental ways to get reimbursed for their most expensive drugs as pressure from patients, employers and politicians to lower drug costs rises, The Wall Street Journal reported.
Traditionally, drugmakers have set a price for a drug and receive payment per pill sold at that price, minus any negotiated rebates. But as drugs costing six figures become commonplace and payers are objecting to covering them, drugmakers are trying new ways to lower costs while still making hefty profits.
Some drugmakers have tried value-based deals, such as Alnylam Pharmaceuticals' agreement to only charge patients full price for its $575,000 drug Givlaari if they see benefits that reflect those seen in clinical trials. It will also make the drug cheaper for payers if more patients than expected take the drug, the Journal reported.
The deal may allow Alnylam to get reimbursed from payers that otherwise might reject such an expensive drug while it maximizes prescriptions, Alnylam CEO John Maraganore, PhD, told the Journal.
Value-based contracts have become more popular as digitized medical records, combined with data analytics technology, make it easier to track how a patient responds to a drug and therefore easier for payers and drugmakers to agree on which metrics to set for value-based payments.
Value-based contracting is "a great lever to pull, but it’s just one more tool in our toolbox," Steve Miller, Cigna's chief clinical officer told the Journal. "It’s definitely not going to revolutionize the system to make it more affordable."
Some drugmakers are trying subscription plans, such as Sanofi's deal to offer insulin at $99 per month.
Novartis is allowing payers five years to pay for its $2.1 million gene therapy drug, Zolgensma.
It is unclear how widely these new models of reimbursement will be adopted, as typically they have only been used for rare disease drugs, not for widely used treatments, according to the Journal.
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