New shops for value-based deals

How new players in value-based pricing are taking the model to new territory

Value-based payment models are starting to appear beyond the high-profile insurers and PBMs that have dominated the scene, with a series of deals struck since August by the Oklahoma Health Care Authority and the University of Pittsburgh Medical Center.

The new players are extending the scope to drugs already on the market and the total cost of care rather than just the cost of the drug.

OHCA, which administers Oklahoma’s Medicaid program covering about 800,000 individuals, struck deals with Alkermes plc, Melinta Therapeutics Inc. and an undisclosed company. UPMC oversees an employer-sponsored plan covering about 3.4 million members, and signed deals with Alkermes and Boehringer Ingelheim GmbH.

Though still few in number, the deals show how companies can work with non-traditional payers to test different outcomes models and expand the range of data about how their drugs work in the real-world setting.

Until now, outcomes-based deals have been the province of a select group of large insurers and PBMs, such as Cigna Corp. and

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