Seeley Elizabeth, Kesselheim Aaron S
Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Harvard University.
Harvard Medical School, Harvard University and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brighams and Women's Hospital.
Issue Brief (Commonw Fund). 2017 Sep;2017:1-8.
Brand-name prescription drug prices are increasing in the United States, putting pressure on payers and patients. Some manufacturers have responded by offering outcomes-based contracts, in which rebate levels are tied to a specified outcome in the target population.
To assess the expected benefits and limitations of outcomes-based pharmaceutical contracts in the U.S., including their potential impact on prescription drug spending.
Semistructured interviews with payers, manufacturers, and policy experts.
Pharmaceutical manufacturers and some private payers are increasingly interested in outcomes-based contracts for high-cost brand-name drugs. But the power of these contracts to curb spending is questionable, largely because their applicability is restricted to a small subset of drugs and meaningful metrics to evaluate their impact are limited. There is no evidence that these contracts have resulted in less spending or better quality.
Outcomes-based contracts are intended to shift pharmaceutical spending toward more effective drugs, but their impact is unclear. Voluntary testing and rigorous evaluation of such contracts in the Medicare and Medicaid programs could increase understanding of this new model.
美国品牌处方药价格不断上涨，给支付方和患者带来压力。一些制造商通过提供基于结果的合同做出回应，在这类合同中，回扣水平与目标人群的特定结果挂钩。
评估美国基于结果的药品合同的预期收益和局限性，包括其对处方药支出的潜在影响。
对支付方、制造商和政策专家进行半结构化访谈。
制药商和一些私人支付方对高成本品牌药的基于结果的合同越来越感兴趣。但这些合同抑制支出的能力值得怀疑，主要是因为其适用性仅限于一小部分药物，且评估其影响的有意义指标有限。没有证据表明这些合同导致了支出减少或质量提高。
基于结果的合同旨在将药品支出转向更有效的药物，但其影响尚不清楚。在医疗保险和医疗补助计划中对这类合同进行自愿测试和严格评估，可能会增进对这种新模式的理解。
