Can Pay-For-Results Drug Pricing Work? A Q&A With Michael Sherman
Summary
It’s been almost a year since Harvard Pilgrim Health Care signed what’s known as a “value-based agreement” with Spark Therapeutics to cover Luxturna , Spark’s $850,000 gene therapy for a form of vision loss.MS : So one of the caveats here is that if you start with a drug that’s priced three times too high and have a VBA [where only a small amount of money is up for possible refund]—that, in itself, doesn’t necessarily help a lot.MS : One interesting observation is because these drugs [for example, Luxturna, and Alnylam’s Onpattro, for a rare liver disease] at least to date have no competition, one could argue that the manufacturers really have not had to come to the table with an outcomes-based agreement.Well, that seemed like a good idea at the time and it’s still in effect, but at this point, no one questions whether someone taking [Repatha] will experience significant reductions in cholesterol.[In that scenario, we’re asking CMS] not to then require Bluebird to sell [the drug] to all the Medicaid plans at 75 percent off of list [price].
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