Payer and Pharmaceutical Manufacturer Considerations for Outcomes-Based Agreements in the United States

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Joshua D BrownSachin Kamal-Bahl

Abstract

Considerable interest exists among health care payers and pharmaceutical manufacturers in designing outcomes-based agreements (OBAs) for medications for which evidence on real-world effectiveness is limited at product launch. To build hypothetical OBA models in which both payer and manufacturer can benefit. Models were developed for a hypothetical hypercholesterolemia OBA, in which the OBA was assumed to increase market access for a newly marketed medication. Fixed inputs were drug and outcome event costs from the literature over a 1-year OBA period. Model estimates were developed using a range of inputs for medication effectiveness, medical cost offsets, and the treated population size. Positive or negative feedback to the manufacturer was incorporated on the basis of expectations of drug performance through changes in the reimbursement level. Model simulations demonstrated that parameters had the greatest impact on payer cost and manufacturer reimbursement. Models suggested that changes in the size of the population treated and drug effectiveness had the largest influence on reimbursement and costs. Despite sharing risk for potential product underperformance, manufacturer reimbursement increased relative to having no OBA, if ...Continue Reading

Citations

Mar 2, 2019·Expert Review of Pharmacoeconomics & Outcomes Research·Josep Darbà, Meritxell Ascanio
Sep 24, 2020·International Journal of Technology Assessment in Health Care·Weiwei Xu, Jing Wu
Aug 1, 2020·PharmacoEconomics·Carolina Zampirolli DiasAugusto Afonso Guerra-Junior
Sep 5, 2021·PharmacoEconomics·Natalie BohmHamish Laing

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