UPMC Health Plan Announces Agreement for VIVITROL®
PITTSBURGH, Aug. 30, 2018 /PRNewswire/ -- UPMC Health Plan announced today a value-based contract with Alkermes for VIVITROL® (naltrexone for extended-release injectable suspension). This medication is a non-addictive, once-monthly treatment proven to reduce the risk of relapse in opioid-dependent patients when used with counseling following detoxification.
"We think this type of contract changes the paradigm around how we pay for drugs. Rather than the traditional approach of merely paying for the drug, we are now paying for results, which will encourage the insurer and the manufacturer to be on the same page – and that page is the health of the patient," said Chronis Manolis, RPh, chief pharmacy officer at UPMC Health Plan. "This contract is especially critical amid this opioid crisis where we need to provide more access to substance use disorder (SUD) treatments."
The goal of the contract is to align the incentives of the manufacturer, Alkermes, with UPMC Health Plan by linking reimbursement for the drug to positive clinical outcomes among UPMC Health Plan members.
Traditional contracts have historically been hindered by several barriers, including limited collaboration and consensus between prescribers and payers, difficulty measuring value (due to fragmented and limited data sets and lack of consensus on measures), and regulatory concerns.
Dr. William Shrank, chief medical officer at UPMC Health Plan notes, "We think this can be a central strategy to improve value for our members. We will work to improve adherence to VIVITROL, support our members who are trying to avoid dependence on opioids, and remove barriers to access, with the goal of better health. We hope that by aligning incentives to help vulnerable members, and by sharing results of our efforts with the public, we can serve as a testing ground for the rest of the nation."
The development of the value-based contract was led by the Center for Value-Based Pharmacy Initiatives, the UPMC Insurance Services Division's not-for-profit research group. The contract benefited from engagement of leaders across UPMC, an integrated payor and provider. Dr. Shrank and Mr. Manolis both hold leadership roles in the Center for Value-Based Pharmacy Initiatives and are nationally-recognized experts in pharmaceutical outcomes research, pharmacy practice, progressive payment models, and managed care leadership.
About the UPMC Insurance Services Division
The UPMC Insurance Services Division is owned by UPMC (University of Pittsburgh Medical Center) a world-renowned health care provider and insurer based in Pittsburgh, Pa. The UPMC Insurance Services Division – which includes UPMC Health Plan, WorkPartners, UPMC for Life, UPMC for You, UPMC for Kids, and Community Care Behavioral Health — offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance and workers' compensation products and services to more than 3.4 million members. For more information, visit www.upmchealthplan.com.