Harvard Pilgrim Health Care, the Massachusetts-based New England health insurer, has agreed to cover Amgen Inc.’s pricey new cholesterol drug but only in exchange for a discount, along with potential rebates if the treatment fails to meet performance targets, The Boston Globe reported.
“The companies said the deal was the first pay-for-performance contract for the cholesterol drug, called Repatha, though Amgen is negotiating similar pacts with other insurers, the paper said.
Harvard Pilgrim hopes that “the contract can help establish a new model for reimbursing makers of high-priced specialty medicines at a time of mounting concern over spending,” The Globe said.
A report from the Institute for Clinical and Economic Review, a nonprofit organization that last year warned about the costs of new drugs to treat hepatitis C, now says two new drugs — Rapatha, from Amgen, and Praluent, from Sanofi and Regeneron Pharmaceuticals — are vastly overpriced when considering the health outcomes they provide.
The analysis said that, measured by the health benefits, their price should be only a third of the level set by the makers. The report will increase pressure on the drug companies from providers to cut their prices. Meanwhile, Express Scripts, the largest pharmaceutical benefits manager, plans to use the report’s findings in negotiating with these drug companies.