UPMC Health Plan, AstraZeneca Enter Into Value-Based Agreement for Heart Drug

UPMC Health Plan has entered into what it’s calling a pioneering value-based contract with AstraZeneca for its Medicare members taking ticagrelor, the heart drug sold as Brilinta.

Brilinta is a blood thinner that can prevent heart attack, stroke, and other heart problems. It was first approved by the FDA in July 2011.

Tying reimbursement to clinical outcomes, UPMC Health Plan will pay less for the drug if it fails to prevent a heart attack or unstable angina within 12 months of a patient’s first attack. On the flip side, if patients respond well to the treatment, the health plan will pay more.

By moving the drug into a generic drug tier, patients will also see a benefit with increased access and lower out-of-pocket costs, according to UPMC Health Plan, who said the deal “could save a member hundreds of dollars over a year.”

“In alignment with our commitment to ensuring patient access, lowering patient costs, and sustaining innovation, AstraZeneca is pleased to collaborate with UPMC Health Plan on this novel agreement to lower out-of-pocket costs for UPMC for Life Medicare patients through dual-sided risk and proud to stand behind the value of Brilinta in improving patient outcomes,” said Rick R. Suarez, senior vice president, AztraZeneca.

By increasing access and reducing costs, the health plan also hopes to remove a barrier to medication adherence for its members.

The agreement was spearheaded by UPMC’s Insurance Service Division’s nonprofit research group, the Center for Value-Based Pharmacy Initiatives.

“We believe this value-based contract is unique and will fundamentally change the strategies for future contracts,” said Chester Good, MD, MPH, FACP, senior medical director, Center for Value-Based Pharmacy Initiatives, in a statement. “The ultimate winner in this agreement is our members who stand to have greater access to an effective treatment option.”

While these value-based agreements are a relatively new concept, they have been touted as a way to bring down drug costs and have been growing momentum in the industry. In August 2018, Alnylam Pharmaceuticals received approval for patisiran (Onpattro) to treat polyneuropathy caused by hereditary transthyretin-amyloidosis. Soon after, they announced that they would be working with health plans to offer value-based contracts for the treatment, which comes with an annual list price of $450,000.