OBJECTIVES: It is well established that safe and effective drugs alone will not result in improved outcomes. Adherence to drug regimens and lifestyle choices continues to be the main factor behind failure to reach outcomes among patients, particularly among oncology, cardiovascular, infectious and CNS diseases. In response, as outcomes-based contracts have become more prevalent, they have evolved to focus on driving patient behavior and reward those who successfully achieve higher rates of adherence among their patient populations. This study explores the evolution of OBCs from agreements focused on drug performance to ones focused on adherence and the potential impact of leveraging data platforms to drive behavior to support performance, lower overall costs, and improve outcomes.

METHODS: Publicly available information describing all VBAs in the US and EU was collected. Current VBA terms were analysed to consider outcome measures, duration, data collection methods, and applicability across therapeutic areas.

RESULTS: 16 or 21% of the 78 OBCs in the US, and 3 of the 175 OBCs in EU are focused on driving behaviours and rewarding adherence to treatments. Between 2017 and 2018 in the US, there has been a growth in adherence-focused contracts of 33%. The majority of agreements are in CNS disorders, specifically MS and schizophrenia in the US, infectious diseases, specifically Hep C, and cardiovascular, specifically hyperlipidemia. In the EU, all 3 OBCs are within oncology.

CONCLUSIONS: As focus on driving and affecting patient behavior increases, OBCs will continue to evolve to reward medications and manufacturers that are able to support and increase adherence. Technology platforms that are able to interface with stakeholders and enhance patient interaction to drive behaviors will be critical in driving the success of these OBCs. Additionally, as therapies grow in complexity, patient support and stakeholder collaboration will be crucial to drive further adoption.