Sandra Clarke, chief financial officer at Blue Shield of California, spoke with Modern Healthcare about the nonprofit health plan's ongoing efforts to reduce drug prices for its 4.5 million members. Among the efforts, Blue Shield’s recent investment in startup Evio Pharmacy Solutions, which seeks to use data analytics to accelerate value-based payments in the pharmacy space.
Sandra Clarke, chief financial officer for Blue Shield of California, said when she worked in the pharmaceutical industry, there was lots of interest in outcomes-based contracts among her colleagues because proving their drugs' value to patients benefited them as well. Most pharmaceutical companies currently don't offer such contracts, but Evio's ability to produce data across 20 million patients might be enough incentive to participate, she said.
[Clarke] said when she worked in the pharmaceutical industry, there was lots of interest in outcomes-based contracts among her colleagues because proving their drugs' value to patients benefited them as well. Most pharmaceutical companies currently don't offer such contracts, but Evio's ability to produce data across 20 million patients might be enough incentive to participate, she said."I believe there is interest, but it has to be done in a way that is transparent and everyone believes they have an equitable opportunity to be compensated for the value that the drug is bringing," Clarke said.
Outside of the companies behind Evio, health insurer Cigna struck up outcomes-based contracts with drugmakers Amgen and Sanofi in 2016. The deals held that if Cigna's members didn't lower their bad cholesterol levels at least to the level experienced by clinical trial subjects, the drugmakers would discount the drugs. Also in 2016, Amgen signed a similar contract with insurer Harvard Pilgrim concerning the same drug.
The insurers behind Evio claim they'll pass along the money they save from the venture to their members, mostly through lower premiums. Blue Shield of California, for example, pledges anything above 2% of its net income against revenue be returned to members, who will eventually see lower premiums if Evio pays off.
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