Drug maker AstraZeneca agreed to a new effectiveness-based pricing deal for its antiplatelet agent ticagrelor, with the University of Pittsburgh Medical Center (UPMC) Health Plan paying a discounted rate for the drug if it fails (and more if it prevents another heart attack within 12 months). The plan also lowers out-of-pocket costs for patients (from $45 to $10 for a monthly supply), bringing the price in line with generics and incentivizing patients to fill their prescriptions.
“There are many patients today who are not taking their [blood thinners] because they say their out-of-pocket costs are too high,” Rick Suarez, senior vice president of market access at AstraZeneca, told STAT News. “This is a way to move the conversation away from list price … and, in turn, for the government to see there can be cost savings in the overall health care system.”
Other drug manufacturers and health plans may find mimicking this arrangement difficult; UPMC has an advantage because the organization is led by health-care providers.
Stacie Dusetzina, PhD, associate professor of health policy at Vanderbilt University Medical Center, spoke with STAT News about whether this deal will lower Medicare spending. “It depends on how often those negative outcomes occurred,” she said. “If there are enough benefits compared to the cheaper generic, [UPMC health-care providers] hope to achieve savings.”
Source: STAT News, January 28, 2019.