July 26, 2017
PCMA requested that Milliman estimate the value of direct and indirect remuneration (DIR) for Medicare Prescription Drug Plan (PDP) stakeholders....
PBMs and payers are committed to the affordability and sustainability of the healthcare system and recognize the importance of aligning reimbursement around value instead of volume. Traditionally, risk-sharing agreements between payers and drug manufacturers have not been tied to the value that medications provide. However, the use of real-world clinical and financial outcomes are driving the acceleration of value alignment.
Value and outcomes-based contracts are being developed for drugs that have quantifiable, widely accepted outcomes metrics. Data collected to inform these contracts continue to provide doctors and payers with unique insights that enhance clinical decision-making processes and increase competition across the marketplace.
Broader adoption of value-based contracting requires trust, collaboration, and a willingness to explore new pricing models. In the midst of increasing expenditures, PBMs are asking manufacturers to stand by their products in the real world and leverage the use of specialty pharmacies to provide the right support to patients and providers. By paying for only what works through value and outcomes-based contracts, payers can lower overall costs and preserve valuable resources to fund future innovations in the drug pipeline.