Over the past 2 decades the use of innovative contracts as well as health care delivery in the United States and the reimbursement landscape has continued to evolve, according to findings presented at AMCP 2022 in Chicago, IL.

To inform an online survey from October 2021 of a panel of payers from Xcenda’s Managed Care Network and assess the current landscape of innovative contracting agreements, study authors conducted secondary research.

For the study, 16% of survey respondents were pharmacy benefit managers, 26% were integrated delivery networks, and 58% were health plans. National organizations represented 42% and regional organizations represented 58%.

Furthermore, 74% of survey respondents had been involved with pharmaceutical manufacturers with 57% of that population noting 3 or more pending contracts or contracts executed in the past 5 years.

Contracts that were outcomes-based made up the majority at 84%, quality initiatives, research collaborations and shared-savings models each accounted for 16%, and disease management programs and subscription models each made up 14%.

According to researchers, the top 3 disease areas where innovative contracts have been developed were diabetes (57%), hepatitis C (32%), and multiple sclerosis (27%). When monitoring progress and measuring success, avoidance of resource use (51%) and improvement in clinical outcomes (73%) were the most common measures collected.

“Elements reported to be extremely/very important in establishing partnerships with manufacturers were simple and easily measured outcomes (95%) and reasonable time frame of contract (84%),” wrote researchers. “Unlike traditional volume-based payment, not all innovative contracts were financially linked to rebates, with 41% of respondents reporting that < 50% of their contracts fell in that category.”

Study authors noted payers showed interest in outcomes-based contracts over the next 5 years as well as shared-savings models, which would focus on chronic inflammatory diseases, oncology, and diabetes.

“Contract design and disease areas of focus will continue to adapt with the changing health care landscape,” concluded researchers.

Reference:
Sporck M, Dodda S, Stuchiner A, Sugarman R. Innovative contracts between health care payers and pharmaceutical manufacturers: a survey of US payers. Poster presented at: AMCP 2022; March 29-April 1, 2022; Chicago, IL.