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Lower Copays Sweeten Outcomes-based Deal for Brilinta.

Ed Silverman

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    |June 13, 2019
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    Summary

    UPMC Health Plan incentivizes Brilinta use by reducing patient copays to match generic Plavix costs. This strategy aims to improve patient access to crucial cardiovascular medications.

    Area of Science:

    • Cardiovascular medicine
    • Health economics
    • Pharmaceutical policy

    Background:

    • Brilinta (ticagrelor) is a P2Y12 inhibitor used to prevent thrombotic events.
    • Patient out-of-pocket costs can be a barrier to medication adherence.
    • Health insurance providers explore cost-saving strategies for high-cost medications.

    Purpose of the Study:

    • To evaluate a novel cost-reduction strategy for Brilinta.
    • To assess the impact of copay adjustments on patient financial burden.
    • To align patient costs with those of generic alternatives.

    Main Methods:

    • Analysis of UPMC Health Plan's formulary and copay structure for Brilinta.
    • Comparison of patient out-of-pocket expenses for Brilinta versus generic Plavix.
    Keywords:
    Insurance, Pharmaceutical ServicesTicagrelor

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  • Review of potential financial incentives for the health plan.

    • Main Results:

    • UPMC Health Plan will reduce the monthly copay for Brilinta from $45 to $10.
    • This copay reduction makes the patient cost for Brilinta comparable to generic Plavix.
    • The health plan receives a discount if patients experience heart attack or stroke while on Brilinta.

    Conclusions:

    • The copay reduction aims to improve patient access and adherence to Brilinta.
    • This initiative represents a cost-management strategy for cardiovascular pharmacotherapy.
    • Aligning copays with generics may enhance the use of novel anticoagulants.