Harvard Pilgrim Makes Pay For Performance Deal with Amgen

New England Council members Harvard Pilgrim Health Care and Amgen have entered into an innovative agreement to provide the new cholesterol drug Repatha to patients.

The contract includes a pay for performance guarantee whereby Harvard Pilgrim will pay Amgen based on how effective the drug is. As a result, Harvard Pilgrim patients will be able to receive the drug if it benefits them, but the agreement will also encourage lower cost drugs for those patients for whom it is not as effective. This is the first pay-for-performance contract for this drug. Repatha is a drug for Americans at high risk of heart attacks or strokes, those who cannot tolerate statins (traditional cholesterol medicines) and people with high levels of LDL cholesterol.

“With the cost of new specialty drugs skyrocketing, our arrangement with Amgen will help us contain premium costs for employers and members,” said Harvard Pilgrim Chief Medical Officer Michael Sherman. “As the health care delivery system has moved away from paying fee-for-service toward paying for appropriate outcomes, the pharmaceutical segment has remained primarily in a traditional ‘pay for pill’ model. Agreeing to pricing models that align payment with appropriate outcomes is critical if we are to better manage increasing drug costs. We take very seriously our responsibility to ensure that the dollars we spend on health care are used wisely and give our members access to the highest quality care.”

The New England Council commends Harvard Pilgrim and Amgen on this agreement.

For more information, see this Boston Globe article or this Harvard Pilgrim press release.

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