Highmark is seeing positive results in the first year of its outcomes-based contract with AstraZeneca, and the insurer is looking to leverage those learnings to build its formulary strategy.
The agreement with AstraZeneca for Symbicort, an inhaler that treats asthma and chronic obstructive pulmonary disorder (COPD), was Highmark’s first publicly disclosed, outcomes-based contract with a drug company. It was announced in April 2018, though the agreement began in January of that year.
Kayse Reitmeyer, manager of pharmaceutical relations at Highmark, told FierceHealthcare that Highmark tracked both utilization and certain patient outcomes over the course of 2018. The insurer found that more than half of members with COPD or asthma taking Symbicort saw their symptoms improve or stabilize.
About 30,000 prescriptions for Symbicort were dispensed to Highmark members in 2018.
“No outcomes reimbursement was initiated because the outcomes were positive, which is really great because that’s what we’re driving toward and looking for in these outcomes-based contracts,” Reitmeyer said.
Highmark has since entered outcomes-based contracts with drug companies for several other chronic conditions, including diabetes and inflammatory bowel disease. It’s not alone. A recent survey from Avalere shows 58% of insurers had an outcomes-based agreement in place with a drugmaker in 2019.
That’s a significant increase from 24% of payers in 2017, Avalere found.
Reitmeyer said that Highmark has to date focused on contracts for drugs that treat high-cost chronic illnesses that are already on its formulary, with the goal of gathering data that could be used to drive changes to the formulary in the future.
While drugs are placed on the formulary based on clinic trial performance, having data from an outcomes-based model can provide a closer look at how effective pharmaceuticals are within Highmark’s membership specifically, she said.
“A lot of what we’re focusing on now is tracking this real-world evidence and using that to generate some evidence to support our formulary positioning,” she said.
In the future, Highmark is looking to take the outcomes and use that information to look at their formulary through a “different lens,” Reitmeyer said. Plus, while there’s been plenty of fanfare around insurers entering these arrangements, the actual outcomes data have been limited so far.
“I think that we were pretty excited to put the results out there for this one,” she said. “We haven't seen a whole lot of results yet for outcomes-based contracts.”