OBJECTIVES The objectives for this research are to:
- understand the level of familiarity and use of OBC amongst payer segments;
- understand key payer objectives in negotiation of OBC; and,
- determine OBC failure reasons and timing; and 4) identify OBC models with high likelihood of success.
METHODS 422 formulary decision makers from US payer segments were invited via email to participate in a 14 question web-based survey in July 2018. To be included in the study, respondents had to currently or within the past two years have been involved in making drug coverage decisions. 30-minute telephone interviews were conducted with 4 respondents to extrapolate aspects of the survey results. Descriptive statistics were used to report the results and presented as word counts and percentages. RESULTS A total of 22 respondents met inclusion criteria for the web survey, representing 121. 2 million covered lives. 55% have implemented an OBC in the past 5 years. OBC show most promise in cardiovascular disease (37%), oncology (18%), and immunology/inflammation (18%). Out of 4 potential OBC models, 45% said clinical performance models (rebate tied to performance of clinical measure) have the most potential for success. 45% said they expect manufacturers to take on a high degree of financial risk; 27% said they expect manufacturers to take on a moderate degree of financial risk. High implementation costs is the most common reason for OBC implementation/negotiation failure. Out of 6 potential steps, the first step (identification of shared interests and initial discussion of needs, priorities, and feasibility) was the most common stage for OBC failure (32%). CONCLUSIONS OBC in the US is growing rapidly as a method to control drug spend. Manufacturers should plan OBC-friendly clinical programs with measurable endpoints in the real world to mitigate higher degrees of financial risk expected by payers. Both manufacturers and payers should develop strategies to better overcome early-stage OBC failure rates and find cost-effective methods to collect and analyze data.
