Prime Inks Outcomes-Based Deal With Biogen for MS Drugs

Prime Therapeutics LLC continues to sign agreements for its outcomes-based contracting program, known as CareCentered Contracting. The latest manufacturer to enter into an arrangement is Biogen, which inked a deal for its multiple sclerosis (MS) disease-modifying agent portfolio: Avonex (interferon beta-1a), Plegridy (peginterferon beta-1a), Tecfidera (dimethyl fumarate) and Tysabri (natalizumab).

The MS therapeutic class consistently ranks among the top three in terms of specialty drug spend among PBMs that track those data.

For the first half of 2017, Prime said MS was the fifth most costly drug category among commercial clients, accounting for 5.0% of total drug spending (before rebates and inclusive of discounts) and a 4.2% trend (after rebates and discounts). Teva Pharmaceutical Industries Ltd.’s MS therapy Copaxone was the sixth costliest drug, accounting for 1.3% of spend, according to Prime’s Fall 2017 Mid-Year Update, released Oct. 12.

In all, Prime’s total specialty trend for its commercial clients was 15.2%, composed of a 3.7% increase in unit cost and an 11.5% boost in utilization. But, countered by a negative 5.1% total traditional trend, Prime’s overall drug trend was 0.8% when compared with the same period in 2016,

Although Prime and Biogen signed one agreement for the portfolio as a whole, “each medication is measured separately,” says Susan Scheid, vice president of pharmaceutical trade relations at Prime, a PBM owned by 18 Blue Cross and Blue Shield plans. Specifically, “Prime will measure our members’ overall appropriate medication use to ensure we are maximizing the benefits of the MS drugs.”

“Members’ medication persistency will be measured quarterly,” she tells AIS Health, and “additional reimbursement is provided to our clients if agreed-upon persistency levels are not achieved.” The initial period of measurement runs through 2018, and the contract “will be evaluated at that time for additional term length.”

Asked how the arrangement came about, Scheid says that “Prime maintains ongoing relationships with manufacturers in an effort to optimize our members’ experience with their prescription drug therapy. Through continuous engagement, an outcomes-based contract emerged as one strategy to provide value to our clients by aligning drug price to clinical value.”

The MS disease-modifying agents are good candidates for outcomes-based contracts because “taking them consistently and as prescribed will provide the best chance for improving the member’s health, slowing disease progression and limiting additional health care services,” she says.

Overall, Prime has deals for “several” therapies through the program, explains Scheid.

“We’re committed to continued innovation in our CareCentered Contracting program,” she tells AIS Health. “Manufacturers are taking note of Prime’s ability to measure and analyze claims data trends, and we expect to move forward with more CareCentered agreements and additional program designs in the near future.”

by Jane Anderson

Adapted from the 1/15/18 issue of AIS’s Health Plan Week