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The writing has been on the wall from some time. The push for value-based care has had a domino effect on biopharmaceutical manufacturers. The new industry trend will be for them to go “at-risk” in negotiations with payers and PBMs for new high-cost specialty therapies.

Factors that increase the need for biopharma manufacturers to go at risk:

  1. Increasingly stringent and complex payers’ prior authorization requirements
  2. A proven value-based drug, Harvoni, not meeting real-world expectations set by its clinic trial results and advertisement campaign
  3. The development of new high-cost therapies

Prompted by the steady rise in new high-cost therapies, at-risk contacts between payers and manufacturers are looking increasingly inevitable.

“Focusing on patient outcomes and additional services by specialty pharmacies mirrors the move Medicare is making toward value-based care for reimbursements. As these forces grow in influencing the health care system, the beneficiaries will be patients whose lives improve, the manufacturers who can more effectively account for the value their therapies provide, and the payers whose highly adherent patients experience fewer instances of more costly acute care.”

Pharmaceutical manufacturers’ day at-risk has arrived.

Negotiated “at-risk” contracts that include the engagement of pharmacy partners with medication management protocols proven to improve adherence and outcomes, agreed upon up-front data sharing and outcomes measurement, and neutral arbiters of that data have the capability of making this development an industry-wide win.”

To read Curant’s full article on biopharmaceutical manufacturers going at-risk, visit Specialty Pharmacy Times.

To read our post on what to consider when negotiating at-risk contracts, click here.