Harvard Pilgrim Health Care has signed an innovative outcomes contract based on therapy effectiveness with Amgen for its rheumatoid arthritis drug, Enbrel. This contract represents another move by Harvard Pilgrim to reimburse based on value to the patient, and not solely on volume of medicine sold.
Enbrel is a biologic medicine that works on the immune system and is used to treat moderate to severe rheumatoid arthritis, as well as other autoimmune diseases. It can help relieve joint pain and stiffness and reduce fatigue in patients with rheumatoid arthritis and also has the ability to help prevent further joint damage. Enbrel is administered by self injection weekly.
The two-year contract is based on an effectiveness algorithm driven by six criteria, including patient compliance, switching or adding drugs, dose escalation and steroid interventions that can serve as a global measure of the positive impact on Harvard Pilgrim members. If patient scores are below a specified level, Harvard Pilgrim will pay less for Enbrel because its real life effectiveness will have been lower.
The contract also calls for the tracking of patient adherence to the drug. It is the only outcomes-based contract of its kind in the market for the treatment of moderate to severe rheumatoid arthritis.
“Real world performance of new medicines frequently differs from the well-controlled clinical trial setting,” said Harvard Pilgrim Chief Medical Officer Michael Sherman, “and we know that historically, only about a third of patients on Enbrel and others in this class meet all six criteria. By linking the ultimate cost of this drug to its real-world clinical efficacy, this agreement truly puts patients at the center of focus.”
“Amgen champions the need to measure and reward value-based healthcare. This ground-breaking agreement with Harvard Pilgrim, the first of its kind in rheumatoid arthritis, aims to demonstrate the value of using Enbrel to effectively treat patients and provides powerful evidence to be considered by formulary decision-makers in the future,” said Joshua Ofman, M.D., Senior Vice President of Global Value Access & Policy. “Amgen is committed to innovating approaches to improve population health and sustain access to treatments that provide tremendous value to patients.”
Filed Under: Drug Discovery