Highmark announces new drug contract

PARKERSBURG — Highmark has announced a new contract for a drug for patients with diabetes.

To address high prescription drug costs, Highmark announced an outcomes-based contract with Boehringer Ingelheim for Jardiance (empagliflozin), an oral medicine to lower blood sugar in adults with type 2 diabetes and to reduce the risk of cardiovascular death in adults with type 2 diabetes who have cardiovascular disease. Jardiance is a product by Boehringer Ingelheim and Eli Lilly and Co.

The contract focuses on an analysis of the 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. This analysis is important given that cardiovascular disease is the leading cause of disability and death for people with diabetes.

“We’re committed to prioritizing contract agreements which drive members to clinically effective treatments while also managing the cost of care,” said Ryan Cox, RPh., 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.”

Applicable to commercial members in Highmark’s national and core health insurance markets in Pennsylvania, West Virginia and Delaware, the agreement’s 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® XR (empagliflozin and metformin hydrochloride extended-release) or Glyxambi® (empagliflozin/linagliptin) — with the medical and pharmacy costs of all other antidiabetic medications.

“The fundamental goal in this contract is to improve outcomes for our members. In an ideal scenario, Highmark would not see any additional financial savings because Jardiance is performing as we anticipated,” said Kayse Reitmeyer, pharmaceutical manufacturer relations director at Highmark. “By negotiating value-based contracts like this one, we’re building structures that facilitate payment for quality of care over quantity or volume of care.”

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 extracted 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,” said Cox.