A recent study conducted by the Academy of Managed Care Pharmacy (AMCP) and Xcenda found that 71 percent of insurers and 63 percent of biopharmaceutical companies surveyed were interested in pursuing outcomes-based contracts, one type of value-based contract (also known as results-based contracts or RBCs).
To date, 20 percent of insurers and 33 percent of biopharmaceutical companies participating in the survey had at least one RBC in place. These payment arrangements, which tie reimbursement for medicines more closely to results in individual patients, can help ensure treatments and cures are accessible to the patients who need them and may drive savings across the health care system.
Survey respondents identified a range of barriers that limit the uptake of RBCs, including operational issues related to obtaining outcome measures and accurate data as well as outdated regulations that create uncertainty for stakeholders looking to enter into these innovative payment arrangements. Respondents indicated the three most impactful ways to facilitate RBCs:
- Clarification of the Food and Drug Administration’s regulation of communications to payors about information that may be outside of product labeling
- Clarification regarding the application of the Anti-Kickback Statute
- Changes to federal best-price reporting requirements
These findings echo PhRMA's member survey as well as an earlier payer survey on barriers to implementing new approaches to paying for medicines. Addressing these barriers can increase the number and scope of RBCs – an outcome that could help improve patient access and affordability.
Watch our recent video, which highlights the ways that these outdated regulations can discourage biopharmaceutical companies and insurers from pursuing these ways to pay for new medicines.
To learn more, visit http://www.phrma.org/value-collaborative.
Joe Vandigo Joe Vandigo is a health services researcher with a background in patient and stakeholder engagement and claims database analyses. As a director in the Policy and Research department at PhRMA, he focuses on research related to innovative contracting arrangements, manufacturer communication with health professionals, the pharmaceutical supply chain and cancer financial hardship.