All healthcare stakeholders are aware the day is coming when pharma manufacturers will need to go at-risk in order to secure inclusion of their high-cost drugs in plan formularies. This shouldn’t be viewed as simply a unilateral opportunity to force price concessions from manufacturers. Rather, this is an opportunity to place patient outcomes squarely in the middle of the medication price/benefit calculus.
We have identified three key price contract negotiation considerations that should be evaluated to smooth at-risk negotiations and align all parties, including the patient, for value-based success:
- Leverage or create programs that measure and improve adherence beyond MPR. How will patients be engaged and how will that engagement be measured?
- Agree on data sharing and outcomes measurement up front. How close should “real-life” results mirror those achieved under controlled trial conditions?
- Determine who will own, and validate, the agreed upon outcomes data. Ultimately, which stakeholder should be tasked with determining which data is the right data, and who will aggregate, assess and validate the data upon which payment determinations will be made?