UPMC Health Plan announced has entered into a value-based agreement with Biogen for Tecfidera® (dimethyl fumarate) and Avonex® (interferon beta-1a), two specialty medications used to treat patients with relapsing forms of multiple sclerosis (MS).
Previous value-based contracts for MS medications have connected payment to surrogate clinical indicators derived from claims and electronic health record data, such as MS-related emergency department visits, hospitalizations, medication adherence, and relapse rates.
However, a recent study conducted by the UPMC Center for Value-Based Pharmacy Initiatives, the UPMC Insurance Services Division’s non-profit research group, found that a panel of key MS stakeholders, including patients, providers, caregivers, payers, pharmaceutical manufacturer representatives, and pharmacy benefit manager representatives, unanimously ranked “worsening physical disability” as one of the most meaningful MS outcomes.
“This new contract continues the innovative work that we are leading at the UPMC Center for Value-Based Pharmacy Initiatives to change the paradigm around how we pay for medications by utilizing outcome measures that clinically and financially align all of our stakeholders,” said Chronis Manolis, RPh, chief pharmacy officer at UPMC Health Plan. “By incorporating evidence-based findings into contract development and by including a patient-reported outcome that is most valued by our members, stakeholders, and providers, we move further into true risk-based contracting.”
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“This agreement with UPMC Health Plan connects the value of Biogen’s therapies to the real-world outcomes of MS patients. We are grateful to UPMC for their collaboration that will help to ensure access to our therapies for people living with relapsing forms of MS with the aim of supporting a more sustainable and affordable healthcare system,” said Alisha Alaimo, president of Biogen, U.S. organization.
“Our ultimate goal is to mitigate disability progression in our members with MS and to help them maintain active, healthy lives,” Chester “Bernie” Good, MD, MPH, FACP, senior medical director for the UPMC Center for Value-Based Pharmacy Initiatives said. “Both Tecfidera and Avonex are important medications in the treatment of relapsing forms of MS. We are excited to collaborate with Biogen to create a value-based agreement that recognizes the importance of these medications for our members and our physicians.”
The development of the value-based contract was led by the UPMC Center for Value-Based Pharmacy Initiatives and benefited from the engagement of leaders across UPMC, an integrated payer and provider.