OBJECTIVES

: With the introduction of expensive treatments, there is an increase in the adoption of innovative risk-sharing arrangements. Outcomes-based contracts (OBCs) is one such arrangement between the pharmaceutical manufacturers and payers, which involves a provision of discount/rebate to the payer based on the performance of the treatment in a real-world population. The study objective was to identify publicly disclosed OBCs for various marketed drugs.

METHODS

: A traditional literature review was conducted wherein peer-reviewed publications, editorials, and online reports were searched for OBCs. Once OBCs were identified, manufacturer and payer details, drug and disease area, outcome measures and terms of the contract were extracted and summarized. Studies without outcomes description were excluded.

RESULTS

: A total of 28 publicly disclosed OBCs among 12 manufacturers and 8 payers in the United States were identified between January, 2009 and June, 2018. Hypercholesterolemia (n=3), rheumatoid arthritis (n=1), osteoporosis (n=2), diabetes (n=4), congestive heart failure (n=3), multiple sclerosis (n=2), retinal dystrophy (n=1), pain management (n=1), asthma (n=1) and lung cancer (n=1) were included in the OBCs. A number of outcome metrics were utilized in these OBCs including reduction in hospitalization rate (n=8), reduction in clinical aspects such as LDL-C level, fractures, blood sugar level, asthma-related symptoms, sight improvement and relapses (n=13) and medication adherence (n=3). Two OBCs focused on comparison of costs incurred while on manufacturer’s drug and on other drugs for the same disease and two other OBCs measured the quantity of drug consumed by patients as the outcome metric.

CONCLUSIONS

: Through OBCs, manufacturers provided rebates or discounts to payers in return of preferred formulary status. The publicly disclosed OBCs did not provide details on compensations, whether patients' out-of-pocket costs were reimbursed or more importantly, the measurement of outcomes. Also, there is a need to measure the satisfaction of both manufacturers and payers with the implementation of OBCs.