BLOOMFIELD, CT — Cigna and Aetna both announced this week that they're contracting with the manufacturer Novartis on a "pay-for-performance," outcomes-based coverage agreement for the sacubitril/valsartan combination drug known as Entresto. According to a release by Cigna, its payment will depend on relative improvements in patient health, including decreasing heart-failure–related hospitalizations[1].
The company notes that making sure "medications are actually working as or better than expected" is increasingly important to it. "Outcomes-based contracts require that prescription medications perform in the real world at least as well as they did during clinical trials." It adds that the contract is related only to its commercial business.
According to Reuters[2], Aetna's agreement with Novartis is based on results that replicate those found in clinical trials. However, further details have not yet been provided. The Wall Street Journal[3] reports that when the head of Novartis' pharmaceutical division David R Epstein announced in a January fourth-quarter earnings call that the company had signed deals with two insurers, he was referring to Aetna and Cigna.
As reported by heartwire from Medscape, the FDA approved the angiotensin-receptor/neprilysin inhibitor (ARNI), formerly known as LCZ696, last July for reduced-ejection-fraction heart failure. The approval was based on the results of the PARADIGM-HF trial, which was presented at the European Society of Cardiology Congress in 2014.
The list price for the drug is $4560 per year, which the Institute for Clinical and Economic Reviews (ICER) noted last fall "can be judged cost-effective in the long term according to commonly accepted cost-effectiveness thresholds."
Heartwire from Medscape © 2016
Cite this: Cigna, Aetna Announce 'Pay-for-Performance' Contracts for Sacubitril/Valsartan (Entresto) - Medscape - Feb 12, 2016.
Comments