Amgen and PBM Forge Outcomes-Based Agreement for Enbrel Ahead of Biosimilar Competition

Amgen and pharmacy benefit manager (PBM) Abarca this week announced that they have entered into an outcomes-based contract for brand-name etanercept, Enbrel.

Under the terms of the agreement, Agmen will provide rebates to the PBM’s clients for members of commercial health plans who start etanercept to treat rheumatoid arthritis (RA), but who discontinue after 3 months of treatment.

Abarca will use its software that tracks utilization in real-time in order to generate the information necessary to track patient discontinuation and trigger rebates from the drug maker.

"This is a win for all parties," Jason Borschow, president and chief executive officer of Abarca, said in a statement. "It will provide Amgen valuable information about how Enbrel is utilized, it will lower costs for plans, and it will bring additional benefits to our healthcare system."

While anti—tumor necrosis factor (anti-TNF) therapies like etanercept can be highly effective treatments for RA, approximately 20% to 40% of patients who start an anti-TNF drug fail to achieve and adequate response to their therapy. These patients may go on to cycle to another anti-TNF drug or change treatment to a biologic with a different mechanism of action altogether, and that process can be a costly one. An outcomes-based contract like the one struck between Amgen and Abarca may help shield PBM clients from some of those costs.

The timing of the deal, which could make the drug an appealing choice for those starting anti-TNF therapy, comes as biosimilar challengers to Enbrel are seeking to enter the market with their approved products.

Sandoz, which developed the biosimilar etanercept Erelzi, was recently delivered a blow when the United States District Court for the District of New Jersey has ruled in favor of Amgen in a long-running patent litigation concerning the biosimilar. Opening briefs have been filed in the US Court of Appeals concerning the case, however, and Sandoz executives have indicated that the company remains dedicated to brining the biosimilar to market as soon as possible. Another biosimilar, Samsung Bioepis’ Eticovo, is also FDA-approved but has yet to launch.

Amgen has previously entered into outcomes-based contracting for etanercept; in 2017, Amgen and Harvard Pilgrim Health Care struck a deal in which patients receiving the drug were scored on criteria including compliance, added drugs, and dose escalation. Patient scores that did not meet a prespecified threshold resulted in lower reimbursement for Amgen.