Study finds nearly half of payers believe innovative contracts can lead to lower patient out-of-pocket costs

Katie Koziara
Katie Koziara May 17, 2021

Study finds nearly half of payers believe innovative contracts can lead to lower patient out-of-pocket costs.

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According to a recent survey by Verpora that will be presented this week at ISPOR, nearly half of U.S. payers surveyed expressed a belief that wider implementation of innovative contracts could lead to lower patient out-of-pocket costs across small molecule, biologic, cell and gene therapies. This echoes the support biopharmaceutical companies have for these innovative contracts, and recent studies that demonstrate the potential impact value-based approaches can have on improving patient health outcomes, decreasing payer costs and lowering patient out-of-pocket spending. 

Verpora’s survey of executives from health plans, pharmacy benefit managers and provider groups further reveals that payers agree – innovative contracts are a win-win for the health care system. The survey found that both regional and national payers believe the enhanced information sharing that’s required for innovative contracts can improve the patient experience through:

  • Increased awareness;
  • More effective treatment management; and 
  • Better care coordination across the health care system. 

Under traditional fee-for-service approaches to care delivery, there is often a lack of alignment and coordination among the various providers and medical facilities delivering care to a patient. Innovative contracts are one tool that may help improve coordination and enable more patient-centric care. They can help to improve therapy adherence and patient outcomes while also tying the cost of the product directly to an outcome or other measure of value or effectiveness. 


Also, 84% of payers surveyed expressed interest in pursuing more or the same number of these contracts in the next 12 months. Through these contracts, payers and biopharmaceutical companies have an opportunity to promote patient access to lifesaving medicines without disrupting incentives for future groundbreaking discoveries – especially crucial as biopharmaceutical companies work around the clock to develop and manufacture treatments and vaccines to defeat COVID-19. 

To access the full range of benefits from innovative contracts, though, there are important barriers and uncertainties that must be addressed. In our recent response to the Health Care Innovation Caucus’s request for information, we highlight the need to update outdated regulations that inhibit the adoption of innovative contracts. While recent rulemaking provided some increased flexibility, further clarifications and protections are needed from the Centers for Medicare and Medicaid Services and the Office of Inspector General to create broader opportunities that can offer improved outcomes and cost savings to patients, payers and providers.

The COVID-19 crisis has further highlighted the need to move toward a more value-driven health care system in which stakeholders work together to improve patient outcomes and reduce costs without sacrificing the quality of care. Innovative contracts are one example of a collaborative solution that can help accomplish this. 

To learn more, visit www.phrma.org/value-collaborative.

Topics: Out-of-Pocket Costs, The Value Collaborative, Value-Based Contracting