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news.Harvard Pilgrim Health Care and Amgen, maker of the new LDL cholesterol lowering drug Repatha, have negotiated an agreement that will help to slow the growth of escalating health care costs and improve care.
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Repatha is one of a new class of biotechnology medicines known as PCSK9 inhibitors. The drugs have demonstrated a promising new approach for treating elevated LDL cholesterol in patients whose levels are not able to be controlled by current treatment options.
The medication is designed to target a protein that prevents the body from removing artery-blocking LDL cholesterol from the bloodstream. Repatha works differently than statin drugs that prevent the liver from making cholesterol.
Given by injection every two or four weeks, Repatha is intended for patients who have an inherited disorder resulting in high levels of LDL cholesterol or have high-risk atherosclerotic cardiovascular disease conditions, such as heart attack or stroke, that have been resistant to treatment.
Harvard Pilgrim’s negotiated contract with Amgen is innovative in that it contains a pay for performance guarantee through which Amgen is taking financial risk by providing the health plan with an enhanced discount if the reduction in LDL levels for Harvard Pilgrim members is less than what was observed during clinical trials.
In addition to the outcomes guarantee, the agreement also provides for additional discounts if utilization of the drug exceeds certain levels. This enables those patients who can most benefit from the drug to receive it while continuing to encourage utilization of lower cost statins for the majority of patients.
Harvard Pilgrim chief medical officer Michael Sherman said: "With the cost of new specialty drugs skyrocketing, our arrangement with Amgen will help us contain premium costs for employers and members.
"As the health care delivery system has moved away from paying fee-for-service toward paying for appropriate outcomes, the pharmaceutical segment has remained primarily in a traditional ‘pay for pill’ model. Agreeing to pricing models that align payment with appropriate outcomes is critical if we are to better manage increasing drug costs. We take very seriously our responsibility to ensure that the dollars we spend on health care are used wisely and give our members access to the highest quality care."