Highmark inks outcomes contract with second pharma brand

Continuing its efforts to address high prescription drug costs, insurer Highmark has entered into a new outcomes-based contract with Boehringer Ingelheim for Jardiance (empagliflozin), an oral medicine indicated to lower blood sugar in adults with type 2 diabetes, and also to reduce the risk of cardiovascular death in adults with type 2 diabetes who have known cardiovascular disease. Jardiance is a product in the Boehringer Ingelheim and Eli Lilly diabetes alliance portfolio.

According to Highmark executives, the new contract focuses on an analysis of the total cost of care for adults with type 2 diabetes and established cardiovascular disease who have been prescribed Jardiance, compared with people who have not been prescribed Jardiance. This analysis is important given that cardiovascular disease is the leading cause of disability and death for people with diabetes.

“We’re committed to prioritizing contract agreements which drive members to clinically effective treatments while also managing the cost of care,” said Ryan Cox, director of specialty pharmacy strategies at Highmark. “It’s estimated that health care costs for Americans with diabetes are more than two times greater than those without diabetes, and we continue to see significant costs across our type 2 diabetes membership base.”

Applicable to commercial members in Highmark’s national and core health insurance markets in Pennsylvania, West Virginia and Delaware, the agreement’s objective is to compare actual per member, per month medical and pharmacy costs of Jardiance – along with other oral fixed-dose treatments containing empagliflozin, including Synjardy (empagliflozin and metformin hydrochloride), Synjardy XR (empagliflozin and metformin hydrochloride extended release), or Glyxambi (empagliflozin and linagliptin) – with the medical and pharmacy costs of all other antidiabetic medications.

“The fundamental goal in this contract is to improve outcomes for our members,” says Kayse Reitmeyer, pharmaceutical manufacturer relations director, Highmark. “In an ideal scenario, Highmark would not see any additional financial savings because Jardiance is performing as we anticipated. By negotiating value-based contracts like this one, we’re building structures that facilitate payment for quality of care over quantity or volume of care.”

Following the one-year contract period, Highmark will review aggregated dollar amounts of corresponding claims and compare those to members not on Jardiance or any other fixed-dose oral treatments containing empagliflozin. As a result, Highmark may realize minimal savings, which would be dependent on the extracted data.

“We’re excited to enter into this outcome-based contract with Highmark to continue our work in improving outcomes for people with diabetes who are at an increased risk for cardiovascular disease,” says Christine Marsh, VP, market access, Boehringer Ingelheim Pharmaceuticals. “Our value-based contracts reflect our confidence in Jardiance to help reduce overall healthcare costs for this community and further our commitment to ensuring Jardiance is accessible to the people who need it.”

This announcement marks the second outcomes-based contract between Highmark and a pharmaceutical company. During April, Highmark entered into a contract with AstraZeneca covering the COPD and asthma medicine Symbicort.

“There’s a national conversation taking place around the increasing costs of pharmaceutical prices for patients, and Highmark is determined to innovate for progressive contracts and agreements which lessen the total burden for those prescribed,” Cox says. “We take being a partner in health care seriously and this agreement is another step in the right direction as we continue to focus on health care experiences founded in quality and affordability.”