Only outcomes contract in the market for treatment of moderate to severe rheumatoid arthritis

Wellesley, MA (February  22, 2017) – Harvard Pilgrim Health Care has signed an innovative outcomes contract based on therapy effectiveness with Amgen for its rheumatoid arthritis drug, Enbrel. This contract represents another move by Harvard Pilgrim to reimburse based on value to the patient, and not solely on volume of medicine sold.

Enbrel is a biologic medicine that works on the immune system and is used to treat moderate to severe rheumatoid arthritis, as well as other autoimmune diseases.   It can help relieve joint pain and stiffness and reduce fatigue in patients with rheumatoid arthritis and also has the ability to help prevent further joint damage.  Enbrel is administered by self injection weekly.

The two-year contract is based on an effectiveness algorithm driven by six criteria, including patient compliance, switching or adding drugs, dose escalation and steroid  interventions that can serve as a global measure of the positive impact on Harvard Pilgrim members.  If patient scores are below a specified level, Harvard Pilgrim will pay less for Enbrel because its real life effectiveness will have been lower. 

The contract also calls for the tracking of patient adherence to the drug. It is the only outcomes-based contract of its kind in the market for the treatment of moderate to severe rheumatoid arthritis.

“Real world performance of new medicines frequently differs from the well-controlled clinical trial setting,” said Harvard Pilgrim Chief Medical Officer Michael Sherman, “and we know that historically, only about a third of patients on Enbrel and others in this class meet all six criteria. By linking the ultimate cost of this drug to its real-world clinical efficacy, this agreement truly puts patients at the center of focus.”

“Amgen champions the need to measure and reward value-based healthcare.  This ground-breaking agreement with Harvard Pilgrim, the first of its kind in rheumatoid arthritis, aims to demonstrate the value of using Enbrel to effectively treat patients and provides powerful evidence to be considered by formulary decision-makers in the future,” said Joshua Ofman, M.D., Senior Vice President of Global Value Access & Policy.  “Amgen is committed to innovating approaches to improve population health and sustain access to treatments that provide tremendous value to patients.”      

About Harvard Pilgrim Health Care
Harvard Pilgrim is a not-for-profit health services company that, along with its subsidiaries, is improving the well-being of its 2.7 million customers.  Harvard Pilgrim’s flagship health plans in New England provide health coverage to 1.3 million members, while another 1.4 million individuals are served through Health Plans, Inc., a subsidiary that provides integrated care management, health coaching and plan administration solutions to self-funded employers nationwide.  Founded in 1969, Harvard Pilgrim has built its reputation on innovation and collaboration with a goal of lowering health care costs, improving care and enhancing the overall member experience. It is known for its excellent clinical programs, customer service, health improvement strategies and innovative tools that offer consumers greater transparency and empower them to make better decisions about their health care. Harvard Pilgrim is home to the Harvard Pilgrim Health Care Institute, a unique collaboration with Harvard Medical School. As Harvard Medical School’s Department of Population Medicine, the Institute is the only appointing department of a U.S. medical school housed within a health plan.   Funded primarily through external government and private sources, it provides critical information to all levels of our health care system on issues affecting population health and health care delivery. Harvard Pilgrim is consistently among America’s highest-rated health plans according to an annual ranking of the nation’s best health plans by the National Committee for Quality Assurance (NCQA)*.

*Harvard Pilgrim Health Care (private HMO/POS and PPO plans) and Harvard Pilgrim Health Care of New England (private HMO/POS plans) have been rated 4.5 out of 5 in NCQA’s Private Health Insurance Plan Ratings 2016-17. NCQA’s Private Health Insurance Plan Ratings 2015-16. NCQA’s Private Health Insurance Plan Rankings, 2011-15, HMO/POS/PPO.


Harvard Pilgrim Health Care
Mary Wallen
(617) 509-2419