Value-Based Contracts Are Evolving

US Payers Turn To High Cost, Curative Therapies

Value-based contracting in the US is moving toward high-cost drugs for rare disease and away from lower cost chronic treatments as payers plan for the coming pipeline of cell and gene therapies. Marketed gene therapies all have some kind of risk sharing deal in place but further progress on the most innovative payment models is hampered by regulatory and operational challenges.

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Payers Redirecting Focus Of Value-Based Agreements • Source: Shutterstock

After experimenting with value-based contracts over the past three to four years, US payers are shifting their deal-making focus from chronic use drugs to high-cost agents like cell and gene therapy. The change reflects payers’ growing sense that value-based or outcomes-based contracts for chronic use therapies can be more trouble to hammer out than they are worth. Another driving factor is that highly expensive gene therapies are beginning to reach the market, more are coming, and collectively they are expected to pose a serious reimbursement challenge.

The value-based purchasing environment has matured over the last four years, where before there was more talk than actual contracting....

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