Highmark announces outcomes-based contract for diabetes drug


Highmark Inc. today announced its latest outcomes-based contract with Boehringer Ingelheim for Jardiance (empagliflozin).

The oral medicine lowers blood sugar in adults with type 2 diabetes, and also to reduce the risk of cardiovascular death in adults with type 2 diabetes who have known cardiovascular disease. Jardiance is a product in the Boehringer Ingelheim and Eli Lilly and Company diabetes alliance portfolio.

The contract focuses on an analysis of the total cost of care for adults with type 2 diabetes and established cardiovascular disease who have been prescribed Jardiance, compared with people who have not been prescribed Jardiance.

“We’re committed to prioritizing contract agreements which drive members to clinically-effective treatments while also managing the cost of care,” said Ryan Cox, director of specialty pharmacy strategies at Highmark Inc. “It’s estimated that health care costs for Americans with diabetes are more than two times greater than those without diabetes, and we continue to see significant costs across our type 2 diabetes membership base.”

The program applies to commercial members in Highmark’s national and core health insurance markets in Pennsylvania, West Virginia and Delaware.

The contract is also aimed at reducing chances that physicians are prescribing more expensive drugs that are no more effective than less expensive options. The company takes pains to say that if a more expensive drug is more effective, it will be used.

Acocording to a release, the objective is to compare actual per member, per month medical and pharmacy costs of Jardiance – along with other oral fixed-dose treatments containing empagliflozin, including Synjardy (empagliflozin and metformin hydrochloride), Synjardy (empagliflozin and metformin hydrochloride extended-release) or Glyxambi (empagliflozin/linagliptin) – with the medical and pharmacy costs of all other antidiabetic medications.

Following the one-year contract period, Highmark will review aggregated dollar amounts of corresponding claims and compare those to members not on Jardiance or any other fixed-dose oral treatments containing empagliflozin. As a result, Highmark may realize minimal savings, which would be dependent on the data.

“We’re excited to enter into this outcome-based contract with Highmark to continue our work in improving outcomes for people with diabetes who are at an increased risk for cardiovascular disease,” said Christine Marsh, vice president, Market Access, Boehringer Ingelheim Pharmaceuticals, Inc. “Our value-based contracts reflect our confidence in Jardiance to help reduce overall healthcare costs for this community and further our commitment to ensuring Jardiance is accessible to the people who need it.”

This announcement marks the second outcomes-based contract between Highmark Inc. and a pharmaceutical company.

“There’s a national conversation taking place around the increasing costs of pharmaceutical prices for patients, and Highmark is determined to innovate for progressive contracts and agreements which lessen the total burden for those prescribed,” continued Cox. “We take being a partner in health care seriously and this agreement is another step in the right direction as we continue to focus on health care experiences founded in quality and affordability.”

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