Amgen and Harvard Pilgrim Healthcare announced a 2-year contract in which Harvard Pilgrim will pay less for Amgen’s biologic drug etanercept (Enbrel) if patients score below certain levels on measurements of 6 criteria. The contract represents another action by Harvard Pilgrim is to reimburse based on value to the patient, and not solely on volume of medicine sold, according to the insurer. Enbrel is approved for the treatment of moderate to severe rheumatoid arthritis (RA), plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis.
The 6 criteria measured include patient compliance, switching or adding drugs, dose escalation, and steroid interventions that can serve as a global measure of the positive impact on Harvard Pilgrim members. “If patient scores are below a specified level, Harvard Pilgrim will pay less for Enbrel because its real-life effectiveness will have been lower,” the company states. The insurer said that tracking patient adherence to the drug is the only outcomes-based contract of its kind in the market for the treatment of moderate to severe RA. “Real-world performance of new medicines frequently differs from the well-controlled clinical trial setting, and we know that historically only about a third of patients on Enbrel and others in this class meet all 6 criteria,” said Harvard Pilgrim chief medical officer Michael Sherman. By linking the ultimate cost of Enbrel to its real-world clinical efficacy, the contract puts the focus on the patients, he said.
Amgen’s statement said the agreement with Harvard-Pilgrim aims to demonstrate the value of using Enbrel to effectively treat patients, and provides powerful evidence to be considered by formulary decision-makers in the future. The action may signal that Amgen is ready to negotiate with other health insurers to gain some kind of preference for Enbrel over etanercept biosimilars that are likely to be marketed in the future.1 The FDA approved Novartis/Sandoz’s etanercept biosimilar Erelzi in August 2016, but Amgen’s court case against Novartis/Sandoz has put Erelzi’s launch in limbo, with the patent fight likely to last into 2018.2 A company spokesperson said its work with value-based contracts and partnerships “is about rewarding medicines that deliver value and solutions to patients,” and not a reaction to expected competition from Enbrel biosimilars.1
Amgen has previously negotiated a pay-for-performance agreement with Harvard Pilgrim for its cholesterol-lowering drug evolocumab (Repatha), which allowed Amgen an exclusive role in the insurer’s formulary in return for a discount and future rebates if Repatha did not perform as expected.1
Harvard Pilgrim is a Wellesley, Massachusetts-based not-for-profit health services company with 2.7 million customers.
1. Palmer E. Amgen strikes Enbrel “outcomes” contract with Harvard Pilgrim. Fierce Pharma Website. Available at http://bit.ly/2kTQ3re. Published February 22, 2017.Accessed February 23, 2017.
2. Palmer E. Sandoz head: Enbrel biosimilar Erelzi won’t launch before 2018, delayed by legal battle. Fierce Pharma Website. http://bit.ly/2jMIPR9. Published January 25, 2017. Accessed February 23, 2017.