Aetna, Merck Reach Value-Based Deal on Diabetes Drugs and Collaborate on Wellness

The pay-for-performance deal comes as Januvia faces increased competition from newer drug classes, especially SGLT2 inhibitors and GLP-1 receptor agonists.

Aetna announced yesterday that it had reached agreements with the pharmaceutical manufacturer Merck on a value-based reimbursement deal for its blockbuster diabetes drug Januvia (sitagliptin), and that the 2 healthcare giants would also share information for a wellness initiative aimed at making sure patients take medication as directed, as well as following proper diet and exercise.

The pay-for-performance deal for Januvia comes as the dipeptidyl peptidase-4 (DPP-4) inhibitor, which had $3.99 billion in sales in 2015, faces increased competition from newer classes of therapy for type 2 diabetes (T2D). Most notable are the sodium glucose co-transporter-2 (SGLT2) inhibitors and the glucagon-like peptide-1 (GLP-1) receptor agonists. One SGLT2 inhibitor, Jardiance (empagliflozin), by Boehringer Ingelheim and Eli Lilly, and a GLP-1, Novo Nordisk’s Victoza (liraglutide), have been shown in studies to have a cardiovascular benefit.

The value-based agreement covers both Januvia and Janumet, which combines sitagliptin with metformin. The wellness initiative, called AetnaCare, will be launched through 2 accountable care organizations based in New Jersey, according to Aetna spokeswoman Caryn Marshall.

Payers have increasingly discussed reimbursement based on performance as a way to ensure that they get clinical value from increasingly expensive diabetes therapies. A statement from Aetna said the program will use “predictive analytics to identify target populations and proactively curate various health and wellness services that are available to each member.” In an email, Marshall said the initiative will use Merck's Adherence Estimator to identify those patients with specific barriers to taking medication as directed.

Spotting those patients most likely to have poor medication adherence—for reasons that can range from forgetfulness to not having money for co-pays—can be a way to head off poor clinical outcomes that would affect reimbursement. Taking diabetes therapy consistently is key to ensuring improved glycated hemoglobin levels and avoiding complications.The AetnaCare program also includes support services to “reinforce healthy lifestyle behaviors,” according to the statement, which said the program includes:

· Real-time targeting of at-risk populations using advanced analytics

· Customized “care maps” to help patients find evidence-based support services

· “Health ecosystem curation” to steer patients to both clinical and non-clinical services to ensure support for diabetes care.

In the e-mail, Marshall said Aetna is in discussions with community and social services, pharmacists, dietitian services, retail clinics, and services that provide cloud-based storage for connected glucometer readings.

The move comes as T2D therapy manufacturers are under increased pressure on both price and performance. The nation’s largest pharmacy benefit managers, Express Scripts and CVS/Caremark, left off a number of insulin and non-insulin diabetes therapies from their formularies for 2017.