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Performance-Based Risk-Sharing Arrangements: U.S. Payer Experience.

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Performance-based risk-sharing arrangements (PBRSAs) are challenged by administrative hurdles. Easily obtainable drug data and standardized contracts are key to successful PBRSA execution and value-based healthcare.

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Area of Science:

  • Health economics
  • Pharmaceutical policy
  • Managed care

Background:

  • Global concern over rising drug costs drives adoption of performance-based risk-sharing arrangements (PBRSAs).
  • PBRSAs involve manufacturers sharing financial risk with healthcare purchasers.
  • Administrative and legal challenges have hindered successful PBRSA implementation in the U.S.

Purpose of the Study:

  • Identify drug and disease characteristics that contribute to successful PBRSAs.
  • Determine contract components crucial for PBRSA success.
  • Uncover primary barriers to PBRSA execution.
  • Explore solutions to facilitate PBRSA negotiation and implementation.

Main Methods:

  • A 37-item web-based survey was distributed to 90 pharmacy and medical directors.
  • Survey data were collected in July-August 2016 and analyzed using Kruskal-Wallis and chi-square tests.
  • Responses were anonymized, and data were aggregated for analysis.

Main Results:

  • Twenty-seven surveys were completed (30% response rate); most respondents were from regional health plans covering over 1 million lives.
  • Easily obtainable drug and medical data were critical for PBRSA success, with pharmacy claims and patient demographics being readily accessible.
  • Key factors for success included manufacturer payment structure for performance failures, endpoint measurement, and necessary clinical data.
  • Standardized contract templates and transparent financial risk evaluation were identified as crucial for facilitating PBRSAs.

Conclusions:

  • Drug use in chronic conditions and objective performance measures are favorable for PBRSA satisfaction.
  • Standardized contracting templates and increased manufacturer stake can enhance PBRSA uptake and success.
  • Successful PBRSAs may advance the adoption of value-based payments in the U.S. healthcare system.