Cigna Corp. announced that it secured value-based contracts for both PCSK9 inhibitor drugs used for cholesterol therapy. Cigna said the cost of alirocumab (Praluent, Sanofi and Regeneron) and evolocumab (Repatha, Amgen) is now tied to how well the drugs perform within their patient population in comparison with results from clinical trials.

“If Cigna's customers aren’t able to reduce their LDL-C levels at least as well as what was experienced in clinical trials, the two pharmaceutical companies will further discount the cost of the drugs,” Cigna said. “If the drugs meet or exceed expected LDL-C reduction, the original negotiated price remains in place.”

Cigna will use integrated pharmacy and clinical data to determine other potential positive outcomes, such as reduced cardiovascular events.

Our Take: All indications point to this agreement being driven by Cigna, most likely by Christopher Bradbury, senior vice president, integrated clinical and specialty drug solutions for Cigna Pharmacy Management. Cigna has been the most aggressive payer so far in value-based contracting with manufacturers, with agreements for drugs to treat cholesterol (Crestor [AstraZeneca] and Repatha, Praluent); heart failure (Entresto [Novartis]); diabetes (Januvia/Janumet [Merck]); multiple sclerosis (Rebif [EMD Serono]) and hepatitis C (Harvoni [Gilead Sciences]). One source indicates that the Gilead agreement is contingent upon the drug’s success in eliminating the disease.

Where results are identifiable and measurable—such as cholesterol levels, hospitalizations and being free of disease—Cigna has sought out such contracts from the manufacturers we presume they have chosen. In the case of Repatha and Praluent, Cigna contracted with the entire category, although only two drugs represent the entire PCSK9 category today.

The press widely covered this story, and while that alone does not indicate a trend toward outcomes-based contracting, Cigna has demonstrated that it is both willing and able to seek out manufacturers with which to partner.

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