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US Outcomes-Based, Innovative Contracting (OBIC) Tracker – May 2017
Announce three new contracts in one month
Becomes the #1 payer for publishing OBICs
moves into 2nd place with it’s latest contracts for:
Amgen remains #1 manufacturer publishing OBICs
Updated: 05/31/2017
The US OBIC TrackerOutcomes Based, Innovative Contracting
About Stisali & The US OBIC Tracker
The US OBIC Tracker
A ground-breaking, new, complimentary service to track and analyze the quickly evolving horizon of
US value based agreements. The tracker monitors the who, what and when of OBIC, ensuring you
keep up to date on the industry’s very latest developments. In addition, Stisali’s payer experts
provide analysis on the market drivers for OBIC and the levers adopted. The tracker will be
published routinely and inline with market developments.
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To receive your own copy of the US OBIC Tracker please email [email protected] .
Outcomes Based, Innovative Contracting Summary (OBIC) – May 2017
• Harvard Pilgrim:
o announce three contracts in one month
o become the #1 payer for undertaking & publishing OBICs
o start to increase the complexity of their contracts:
• Enbrel deal based on 6 Rx inputs to an algorithm score + adherence
• Brilinta measures secondary hospitalizations for acute coronary
• AstraZeneca move into 2nd place for manufacturers undertaking & publishing OBICs
• Amgen remain the most prolific of manufacturers publishing innovative, outcomes contracts
• U.S. predominately using OBIC to create offensive & defensive strategies in competitive markets
OBIC Academy June 14th Philadelphiaclick for more
Latest OBIC announcement – Harvard Pilgrim & AstraZeneca May 30th 2017
On May 30th 2017 Harvard Pilgrim Health Care signed two innovative, outcomes-based
contracts with AstraZeneca for medicines to treat acute coronary disease and Type II
diabetes. The first is a three-year contract for Brilinta, a medication used to lower a
patient's chances of having another heart attack or dying from one.
Harvard Pilgrim will be monitoring specific criteria in patients following discharge from a
hospitalization for acute coronary syndrome. The outcome will focus on measuring the
reduction in hospitalizations for repeat acute coronary events for patients on Brilinta as
compared to patients on another oral antiplatelet therapy.
The second contract is for Bydureon, a medication used to control blood glucose levels
in Type II diabetes patients. Harvard Pilgrim will measure HbA1c levels in patients and
evaluate the ability of patients who adhere to Bydureon to get to a predetermined
HbA1c goal.
If the medicines fail to meet the agreed upon outcomes criteria in real patients, Harvard
Pilgrim will be charged a lower amount. Through these contracts, AstraZeneca and
Harvard Pilgrim agree that the health plan will be charged for medicines based on value
to the patient, and not solely on volume of medicine sold.
Source: https://www.eurekalert.org/pub_releases/2017-05/hphc-hps053017.php
OBIC Academy June 14th Philadelphiaclick for more
Latest OBIC announcement – Harvard Pilgrim & Amgen May 2nd 2017
On May 2nd 2017 Harvard Pilgrim announced its second OBIC with Amgen for Repatha.
Described as a first-of-its-kind contract, it is based on the Repatha cardiovascular
outcomes data that were recently presented at the American College of
Cardiology 66th Annual Scientific Session. The contract provides Harvard Pilgrim with a
rebate for the cost of Repatha for an eligible patient who has a heart attack or stroke
while on Repatha.
Joshua J. Ofman, senior vice president of Global Value, Access and Policy at Amgen,
“…Harvard Pilgrim have worked with us to refine their utilization management criteria to
accelerate access for their high-risk patients. We look forward to partnering with other
payers to create similar outcomes-based contracts for Repatha."
This contract builds on Amgen's ongoing work with Harvard Pilgrim.
Source: https://www.amgen.com/media/news-releases/2017/05/amgen-and-harvard-pilgrim-agree-to-first-cardiovascular-outcomesbased-refund-contract-for-repatha-evolocumab/
OBIC Academy June 14th Philadelphiaclick for more
0 2 4 6 8 10 12 14
1998
2009
2011
2012
2014
2015
2016
2017
ND
NUMBER
1998 2009 2011 2012 2014 2015 2016 2017 ND
Total 1 1 3 1 1 6 13 6 3
Number of OBICs Announced in USA per Annum
OBIC Academy June 14th Philadelphiaclick for more
0 1 2 3 4 5 6 7
Genentech
Abbvie
Acordia
Bayer
Lilly
P&G/Sanofi
Boehringer Ingelheim (BI)
EMD Serono
Regeneron, Sanofi
Eli Lilly
Undisclosed
Gilead
Novartis
Merck
Astra Zeneca (AZ)
Amgen
NUMBER OF OBICS SINCE 1998
CO
MP
AN
Y
Rank of US Companies With Most Published OBICs
OBIC Academy June 14th Philadelphiaclick for more
1
1
1
1
1
2
2
2
3
5
7
9
Humana
Catamaran/BriovaxRx
Payers & Patients
CVS Health
UoPMC, Regional Health Plan
Health Alliance
Aetna
Insurers
Express Scripts
Prime Therapeutics
Cigna
Harvard Pilgrim
0 1 2 3 4 5 6 7 8 9 10
PA
YER
NUMBER OF OBICS SINCE 1998
Rank of US Payers By Total Number of OBICs
OBIC Academy June 14th Philadelphiaclick for more
AD Adherence
Cap Number of Patients Capped
CMA Continued Medication Adherence
CO Clinical Outcomes
CU Capped Usage
FS Free stock
IB Indication Based
ICM Improved Clinical Metric
ND Not Disclosed
PPP Pro-active Patient Profiling
Rxᵟ Change in Prescribing
TCC Total Cost of Care
UoPMC University of Pittsburgh Medical Center, Regional Health plan
UR Utilization Reduction
Key
0
1
2
3
4
5
6
7
8
9
UR
ICM
UR & Cap
Rxᵟ & AD
AD
CO -TBC
CO
FS
ICM & Cap
IB
ND
CO & AD
PPP
UR & AD
Primary Payer Landscape for US OBICs
OBIC Academy June 14th Philadelphiaclick for more
0
2
4
6
8
10
12
14
16
18
20
Competitive market
Generic - biosimilar threat
High Cost
Novel agent
Poor outcome trial data vcompetitors
Competitive market& highbudget impact
Distribution of OBIC Types From Published Examples
OBIC Academy June 14th Philadelphiaclick for more
The US OBIC Academy
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learning event to help you develop & deploy value based
agreements in the US.
Course leaders will reveal the payer’s perspective on innovation,
and show how to create effective contracts that provide offensive
strike strategies.
Click now to reserve your place
OBIC Academy June 14th Philadelphiaclick for more
AD Adherence
Cap Number of Patients Capped
CMA Continued Medication Adherence
CO Clinical Outcomes
CU Capped Usage
FS Free stock
IB Indication Based
ICM Improved Clinical Metric
ND Not Disclosed
PPP Pro-active Patient Profiling
Rxᵟ Change in Prescribing
TCC Total Cost of Care
UoPMC University of Pittsburgh Medical Center, Regional Health plan
UR Utilization Reduction
Key
Data – Read Me
Base data collected using desk research on all publicly available information relating to outcomes based, innovative contracts in the USA from 1998 to May 25th 2017.
OBIC is classified as either:
• Outcome payment – reimbursement tied to a clinical &/or process outcome at either individual patient or population level i.e. reduction in a clinical indicator such as HbA1C
and/or
• Conditional payment – payment is contingent on specific short-term health outcome or evidence target i.e. Persistence
and/or
• Innovative contracts i.e. indication based pricing, free stock etc.
Data only relates to bio and pharmaceutical products, not devices and diagnostics
Data does not include traditional, straight discount & rebate deals based on volume &/or usage
Analysis – Read Me
Date – relates to the first evidence of public notification of the OBIC, not contract commencement
Not Disclosed, Undisclosed & ND – insufficient information provided to complete the field
Payer – the name of the payer organization which initiated the contract
OBIC Type – a classification nomenclature applied by Stisali to represent the mechanism used in the contract
Primary Payer Landscape – a classification nomenclature applied by Stisali’s payer team to represent the predominant payer driver for that product &/or drug class at that time of the contract announcement
For any questions relating to the data and/or analysis please contact [email protected]
About Stisali & The US OBIC Tracker
Stisali
Stisali are managed market experts, exclusively specializing in risk share and outcomes based, innovative contracting
(OBIC). The company uses insight and experience gained from mature managed markets to create highly effective
value based agreements for US manufacturers. www.stisali.com
Subscribe
To receive your own copy of the US OBIC Tracker please email [email protected] .
