WELLESLEY, Mass.--(BUSINESS WIRE)--Harvard Pilgrim Health Care and Amgen Inc., maker of the new LDL cholesterol lowering drug Repatha, have negotiated an agreement that will help to slow the growth of escalating health care costs and improve care.
Repatha is one of a new class of biotechnology medicines known as PCSK9 inhibitors. The drugs have demonstrated a promising new approach for treating elevated LDL cholesterol in patients whose levels are not able to be controlled by current treatment options. The medication is designed to target a protein that prevents the body from removing artery-blocking LDL cholesterol from the bloodstream. Repatha works differently than statin drugs that prevent the liver from making cholesterol.
Given by injection every two or four weeks, Repatha is intended for patients who have an inherited disorder resulting in high levels of LDL cholesterol or have high-risk atherosclerotic cardiovascular disease conditions, such as heart attack or stroke, that have been resistant to treatment.
Harvard Pilgrim’s negotiated contract with Amgen is innovative in that it contains a pay for performance guarantee through which Amgen is taking financial risk by providing the health plan with an enhanced discount if the reduction in LDL levels for Harvard Pilgrim members is less than what was observed during clinical trials. In addition to the outcomes guarantee, the agreement also provides for additional discounts if utilization of the drug exceeds certain levels. This enables those patients who can most benefit from the drug to receive it while continuing to encourage utilization of lower cost statins for the majority of patients.
“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.”
About Harvard Pilgrim Health Care
Harvard Pilgrim Health Care is a not-for-profit health services company serving more than one million members in New England. Founded in 1969, the health plan has built its reputation on pragmatic innovation with a goal of lowering costs, improving care and enhancing the overall member experience. Harvard Pilgrim is known for its excellent clinical programs, customer service, health improvement strategies and innovative tools that offer consumers greater transparency and empower them to make better decisions about their health care.
Harvard Pilgrim is consistently among America’s highest-rated health plans according to an annual ranking of the nation’s best health plans by the National Committee for Quality Assurance (NCQA)*.
* Harvard Pilgrim Health Care is currently rated 5 out of 5 for its private HMO/POS and PPO plans and Harvard Pilgrim Health Care of New England is currently rated 4.5 out of 5 for its private HMO/POS plans in NCQA’s Private Health Insurance Plan Ratings 2015-16. NCQA’s Private Health Insurance Plan Rankings, 2011-15, HMO/POS/PPO.