Outcomes-Based Contract Between Highmark, AstraZeneca Reveals Positive Results for Patients With Asthma and COPD

Highmark announced this week that its outcomes-based contract with AstraZeneca for the respiratory combination medication of budesonide/formoterol (Symbicort) revealed positive results in improving outcomes for those with asthma and chronic obstructive pulmonary disease (COPD).

The combination medication, approved for the treatment of asthma and COPD, assists in decreasing inflammation and opening the airways in patients’ lungs. As a way to ensure that members have access to the most clinically effective, cost-efficient medications available, Highmark announced that it had created an outcomes-based contact with AstraZeneca for the medication in April 2018. Highmark and AstraZeneca’s contract for budesonide/formoterol served as 1 of the first outcomes-based agreements involving asthma and COPD.

Outcomes-based contracts set drug companies accountable for the clinical effectiveness of medications and the per-member per-month medical and pharmacy costs for members who use the drug compared with the costs for members who use other drugs for treating their condition. For the contract, Highmark analyzed specific pharmacy and medical criteria to evaluate if asthma- or COPD-related symptoms for their patients using the combination medication were aligned with clinical trial results presented by AstraZeneca.

In relating AstraZeneca’s claimed findings, Highmark set the contract target for patient-experienced exacerbation events at 50% or less in the commercial population. Highmark had more than 30,000 claims for budesonide/formoterol in 2018 from its national health insurance markets and its core health insurance markets in Pennsylvania, West Virginia, and Delaware. Under the contract design, patients had to have a primary diagnosis of COPD or asthma with additional age restrictions for each of the cohorts.

Highmark revealed that in the findings, positive outcomes were exhibited as members met the target goal of experiencing less than a 50% rate of exacerbations.

Sarah Marchè, PharmD, senior vice president of pharmacy services for Highmark, stressed the value of assessing medications to ensure and display efficacy. “Outcomes-based agreements like this show the value of medicines like SYMBICORT to both patients and the health system in reducing exacerbations, hospitalizations, and inpatient visits,” Marchè said.

The insurer additionally found that the number of patients taking budesonide/formoterol who saw a worsening of symptoms requiring them to visit a healthcare provider or hospital was substantially lower than what they expected.

“As Highmark furthers its leadership in value-based strategies, results like these are proof that a shared commitment to identifying the right medicine and approach in a priority therapy area can improve patient outcomes,” Marchè said.