Cigna Establishes Value-Based Contracts for PCSK9 Inhibitors

Cigna has entered into value-based contracts with Amgen and Sanofi/Regeneron for their PCSK9 inhibitors — the first health insurance company to do so.

These contracts will modify the costs of the cholesterol-lowering drugs Repatha and Praluent based on how effective they are in patients.

These specialty drugs were approved by the FDA last year and are intended to reduce LDL-C levels. If Cigna’s customers do not see a reduction in their LDL-C levels similar to what was shown in clinical trials, then the pharmaceutical companies will further discount the drug cost.

However, if the drugs meet or exceed the expected results, then the original price remains the same.

“Pharmaceutical advances hold great promise for improving the health of Cigna’s customers, and outcomes-based agreements help ensure that this promise is delivered,” said Christopher Bradbury, senior vice president, integrated clinical and specialty drug solutions for Cigna Pharmacy Management. “Innovating through the contracting approach is one way we are helping our customers and clients receive more value for their health care dollar.”

By analyzing the integrated medical and pharmacy claim data, Cigna said they will obtain information on whether customers are seeing improvements in cardiovascular health related to PCSK9 inhibitors.

In addition to the contracts with Amgen and Sanofi/Regeneron, Cigna also has other value-based contracts with pharmaceutical companies that cover medications for diabetes, cholesterol, heart failure, hepatitis C, and multiple sclerosis.

These value-based contracts will help align incentives by linking financial costs to improvements in customer health, according to Cigna.