Presentation (CTI)

OBJECTIVES: Value-based agreements (VBAs) aim to address delays in market access caused by budget constraints via linking payment to outcomes or performance. This study aimed to identify the key factors driving successful VBAs between pharmaceutical companies and payers, as well as to examine the barriers to VBA adoption in the United States (US).
METHODS: A targeted literature review of peer-reviewed journal articles and policy reports was conducted using PubMed and Google Scholar on December 19, 2024.
RESULTS: Overall, 9 records were included; three policy reports and six review articles. Several factors emerged as critical to the success of VBAs in the US. 1) Disease-specific focus: VBAs work well for chronic conditions with clear metrics. For instance, REPATHA^®’s agreement linked payments to its ability to reduce LDL cholesterol, balancing patient benefits with payer costs. 2) Patient-centric approach: Successful agreements, like those for JANUVIA^® and JANUMET^®, incorporated both clinical outcomes and quality of life improvements. 3) Innovative payment models: LUXTURNA^®’s pay-overtime model spread payments based on continued effectiveness, reducing financial risk. 4) Regulatory compliance: Adherence to Medicaid best price rules and data privacy requirements are essential. Despite their promise, VBAs face significant barriers: 1) Complexity and resource intensity: Designing and administering VBAs demands substantial resources and collaboration among stakeholders, which can hinder implementation. 2) Data infrastructure challenges: Issues such as data privacy concerns and insufficient real-world evidence pose obstacles to effective monitoring and evaluation. 3) Data sources: Healthcare data sources in the US are not well integrated, necessitating the use of multiple data sources. 4) Financial risks and uncertainty: Unpredictable clinical outcomes and budget constraints can discourage stakeholders from pursuing VBAs.
CONCLUSIONS: VBAs are increasingly enhancing access to innovative medications while ensuring cost-effectiveness. Overcoming adoption barriers requires multifaceted strategies and long-term planning, such as fostering stakeholder alignment and enhancing data collection and analytics capabilities.