Bloomfield insurer Cigna has entered into new value-based contracts with Amgen and Sanofi/Regeneron that modify the cost of the new cholesterol-lowering drugs Repatha and Praluent based on how well customers respond to the medications, Cigna announced.
Praluent and Repatha were approved last year by the U.S. Food and Drug Administration as the first two specialty drugs in a new class known as PCSK9 inhibitors. They are intended for certain individuals at high risk for cardiovascular diseases who aren’t able to adequately control their “bad cholesterol” (LDL-C) levels through other treatments, such as dietary changes and their highest tolerated dose of a statin.
Cigna said it’s the first health insurer to reach value-based agreements for its commercial business with both Sanofi/Regeneron and Amgen for their PCSK9 inhibitor drugs. The contracts are independent of each other, but they share the same overall objective.
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. If the drugs meet or exceed expected LDL-C reduction, the original negotiated price remains in place, Cigna said.
By analyzing integrated medical and pharmacy claim data, Cigna will be able to determine whether there are cardiovascular improvements for Cigna customers related to their treatment with the new medications beyond reduction in their cholesterol levels.
Including the agreements with Sanofi/Regeneron and Amgen, Cigna now has value-based contracts in place with pharmaceutical companies covering medications for cholesterol, heart failure, diabetes, multiple sclerosis and hepatitis C.
