Value-based care contracting for pharmacy drugs: opportunity for the United States.
TL;DR
This analysis presents a path forward for the expansion of VBC to promote orphan drug development, expand access to pharmaceuticals, and improve patient safety and explores different contracting options and paths for organizations like CMS and integrated payer-provider networks.
Abstract
The onset of improved data interoperability required as a result of the 21st Century Cures Act, 92% Health Information Exchange coverage, and lessons learned from European pharmaceutical risk-sharing models present innovative and timely opportunities for the U.S. to adopt pharmaceutical value-based contracting (VBC), which uses drug-level performance to allocate financial risk between payers and manufacturers based on clinical and economic metrics. Having been piloted in Italy, Spain, and the UK, this analysis explores different contracting options and paths for organizations like CMS and integrated payer-provider networks to draw on these lessons to adapt VBC frameworks to the U.S. pharmaceutical landscape. While advances have been seen in other areas of VBC and rising net drug costs year-over-year, only 2.3% of publicly available pharmaceutical VBC contracts have been deployed in the U.S. as compared to 77.9% in Europe. As such, we present a path forward for the expansion of VBC to promote orphan drug development, expand access to pharmaceuticals, and improve patient safety.