Harvard Pilgrim and its members will receive full refund if a cardiac event occurs while on the drug
Wellesley, MA (May 2, 2017) – Harvard Pilgrim Health Care has entered into a first-of-its-kind contract with Amgen for its LDL cholesterol lowering drug, Repatha, that guarantees the health plan and its members will receive a full refund of their costs for the drug if a member is hospitalized for a myocardial infarction or stroke after taking Repatha for six months or more and maintaining an appropriate level of compliance on the drug.
Repatha is one of a new class of biotechnology medicines known as PCSK9 inhibitors that have demonstrated a promising new approach for treating elevated LDL cholesterol in patients whose levels are not able to be controlled by current treatment options. The medication is designed to target a protein that prevents the body from removing artery-blocking LDL cholesterol from the bloodstream. Repatha works differently than statin drugs that prevent the liver from making cholesterol.
Given by injection every two or four weeks, Repatha is intended for patients who have an inherited disorder resulting in high levels of LDL cholesterol or have high-risk atherosclerotic cardiovascular disease conditions, such as heart attack or stroke, that have been resistant to treatment.
“Repatha has been shown to have a significant outcome on reducing cardiovascular morbidity for high risk individuals with elevated LDL cholesterol,” said Harvard Pilgrim Chief Medical Officer Michael Sherman. However, there have been concerns raised about the cost of this new drug relative to existing statin treatments. We hope to negotiate more contracts of this type, in which a pharmaceutical company truly has ‘skin in the game’ going forward. This agreement is the first we have signed in which there is a full refund of all costs related to the medication if the patient experiences a heart attack or stroke while taking it.”
"Cardiovascular disease is the largest public health concern in the world and for high-risk patients who have already had a cardiovascular event or whose genetics puts them at risk, it is important that these patients have access to an effective treatment shown to lower their elevated LDL cholesterol in addition to their current lipid lowering regimen,” said Joshua J. Ofman, M.D., MSHS, senior vice president of Global Value, Access & Policy. "Amgen’s agreement with Harvard Pilgrim demonstrates our commitment to seeking innovative approaches that help break down the barriers of access to Repatha.”
This is the second patient-focused outcomes contract Harvard Pilgrim has negotiated with Amgen for Repatha. In the fall of 2015, the health plan signed an outcomes guarantee through which Amgen provided HPHC with an enhanced discount if the reduction in LDL levels for Harvard Pilgrim members is less than what was observed during Repatha’s clinical trials. In addition, the agreement provides for additional discounts if the utilization of the drug exceeds certain levels. This enables those patients who can most benefit from the drug to receive it while continuing to encourage utilization of lower cost statins for the majority of 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.
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