UPMC Health Plan Announces Innovative, Value-Based Agreement with AstraZeneca

UPMC Health Plan and AstraZeneca today announced the initiation of a pioneering value-based contract effective Jan.1, 2019 for UPMC for Life Medicare members who are prescribed BRILINTA® (ticagrelor), a medication used to lower a patient's chances of having another heart attack or dying from one in the 12 months following a heart attack.

The goal of the contract is to align the incentives of the manufacturer, AstraZeneca, with UPMC Health Plan by connecting reimbursement for BRILINTA® to clinical outcomes in a real-world population. Specifically, reimbursement for the medication will be linked to cardiovascular outcomes for people treated with BRILINTA® following a recent hospitalization for heart attack or unstable angina.

This value-based contract is groundbreaking in two ways: first, the contract reduces out-of-pocket costs for UPMC for Life Medicare members by offering BRILINTA® at a generic drug tier that could save a member hundreds of dollars over a year. The other unique aspect of this agreement is that it includes a shared or two-sided financial risk component between UPMC Health Plan and AstraZeneca. Clinical outcomes will determine the level of shared costs.

Development of this value-based contract was led by the Center for Value-Based Pharmacy Initiatives, the UPMC Insurance Services Division's nonprofit research group, and supported by leaders across UPMC's payer and provider systems, the University of Pittsburgh, and in collaboration with AstraZeneca. Specifically, clinical and academic leadership helped determine which outcomes to measure; clinical leadership supported health plan formulary adjustments; and patients were surveyed to ensure that the agreement reflects their priorities.  

"This type of contract reflects the innovative work that we are leading at the Center for Value-Based Pharmacy Initiatives," said Chronis Manolis, RPh, chief pharmacy officer at UPMC Health Plan. "For example, by incorporating two-sided risk into the reimbursement algorithm, we move further into true risk-based contracting that financially aligns key healthcare stakeholders. In addition, by offering BRILINTA® to patients at a generic tier copay, we improve access to BRILINTA® for our members and make progress toward removing cost as a barrier to medication adherence. Our goal at the Center for Value-Based Pharmacy Initiatives is to change the paradigm around how we pay for medicine while adding incentives in our member care model that improve our members' access to high quality medicines."