Prime Therapeutics and EMD Serono Team Up for Outcomes-Based Rebate Project

Prime Therapeutics and EMD Serono entered into an agreement where patient adherence and health outcomes data determine whether or not rebates are given for a drug.

Pharmacy benefit manager Prime Therapeutics (PBM) and EMD Serono, a subsidiary of Merck KGaA, recently entered into a contract to evaluate medication data based on the health outcomes of patients and the total cost of care and create a rebate program based on this data. The drug being monitored, multiple sclerosis (MS) medication Rebif (interferon beta-1a), is the first drug of its kind to be entered into a rebate contract with Prime’s CareCentered Contracting program.

The contract, which began January 1, 2012, specifies that EMD Serono will pay rebates to Prime on the utilization of Rebif if patients who are on the drug have a higher overall total cost to their plans than patients taking a different MS drug, or if the medication adherence rate remains above a “specified level.”

Prime Therapeutics plans to analyze health outcomes and medication adherence data throughout the contract period to try to accurately estimate the total cost of care (including coordinating medical and pharmacy costs) of patient treatment with Rebif.

“Enabling excellent patient and payer outcomes is more important than ever for biopharmaceutical manufacturers in today’s health care environment,” said Mike Dezelan, senior vice president of managed markets at EMD Serono. “Our innovative contract with Prime will bring greater focus to patient adherence, which we expect will help keep hospitalization and emergency visits to a minimum and maximize cost effectiveness.”

This is the third rebate program in which Prime CareCentered Contracting has entered; the other contracts focused on treatments for osteoporosis and diabetes. The company also has an oncology management program that launched last month, which is not associated with a rebate. These programs exemplify Prime Therapeutics’ focus on cost transparency, for which it was the recipient of the 2012 Transparency in Pharmaceutical Purchasing Standards (TIPPS) certification from the HR Policy Association.

Although pharmaceutical rebates are usually granted when PBMs buy drugs in bulk, specialty medications like Rebif are so expensive that “drug manufacturers are being asked to substantiate the value their medications can provide when taken appropriately,” according to the press release.

Clinical trials demonstrate that a medication works, but they do not measure cost effectiveness or patient adherence. Prime Therapeutics’ strategy, and their cost-reduction programs, could present some solid competition to the other big PBMs, according to Drug Benefit News.