Interested in sharing the research? You can order print copies of many research publications.

Order Reprints

Newsletter Sign-Up

Keep up to date with NPC news and events by signing up for our e-newsletter E.V.I.dently, and our CER Daily Newsfeed.

Subscribe POLICY

Private Sector Risk-Sharing Agreements in the US: Trends, Barriers and Prospects

Background

Risk-sharing agreements (RSAs) between health care payers and pharmaceutical manufacturers link coverage and reimbursement levels to drug performance and/or utilization. There are potential benefits to these agreements, including reducing payers’ risk of a sub-optimal purchase; earlier access to pharmaceuticals for patients and consumers; and more efficient pricing mechanisms. Also, these agreements can be a catalyst for generating an enhanced level of real-world medical evidence.

An academic, peer-reviewed study, conducted jointly by experts from the National Pharmaceutical Council, the University of Washington, Tufts University and the Office of Health Economics (UK) and published in The American Journal of Managed Care, examined the use of RSAs in the United States. The study—which involved a review of an RSA database, interviews with key stakeholders and an online survey—found that there is limited RSA activity in the United States, but interest in the agreements among both payers and manufacturers is strong and a changing health care environment may generate more activity in this arena in the future.

Key Findings

There are compelling arguments for both manufacturers and payers to consider RSAs:

  • Manufacturers said they can use RSAs to differentiate and demonstrate the effectiveness of their product versus their competitors, which can assist payers in making formulary decisions.
  • Payers can utilize RSAs to gain experience with a product, reducing uncertainty regarding clinical value, performance and financial impact.

There are many difficulties inherent in implementing RSAs, particularly outcomes-based agreements: 

  • Significant payer and provider infrastructure is necessary to monitor an outcomes-based agreement. For example, payers may not have the capability to monitor and track the pharmaceutical usage of individual patients.
  • Manufacturers are reluctant to accept financial consequences when they can’t control how a drug is prescribed or used.
  • Agreeing upon outcomes that are meaningful and measurable within a reasonable timeframe is challenging.

Potential for the Future

The study found that there is a belief among stakeholders that more RSA activity could be seen in the future. This expansion could be fueled by (1) improved data systems, which can help create the mechanisms to monitor patient usage of pharmaceuticals and their effect on health outcomes; and (2) the changing of incentives within the health care system toward value-based orientations. The increased use of accountable care organizations, for example, may lead to enhanced health system alignment with risk-sharing agreements.

Newsletter Volume

E.V.I.dently January 2016

MessageThe Importance of Evidence, Value, Access and Innovation in 2016In his annual health care outlook, NPC President Dan Leonard explains why...
Commentary and Testimony Page

The Importance of Evidence, Value, Access and Innovation in 2016

Last year, in our 2015 Health Care Outlook published in Chain Drug Review, I highlighted the recent announcement by the U.S. Department of Health and...
Blog Post

Can We Work Together to Ensure Patient Access to Treatments and Encourage Innovation?

Is it possible for all health care stakeholders to work together to develop solutions for containing costs that ensure patient access to care and...
Blog Post

The Shift to Value-Based Care: Balancing Quality Improvement with Patient Access

Over the last few years, there has been a significant shift throughout our health care system to move to a delivery and payment model known as value-...
Press Release

Pharmaceuticals Play Key Role in Achieving ACO Quality, Cost Goals

WASHINGTON, DC, July 18, 2012–As health care providers set up accountable care organizations (ACOs) and other value-based care programs,...
Press Release

Avalere Explores Impact of Comparative Effectiveness Research on Healthcare Innovation

Washington, DC (November 17, 2009) – A new Avalere Health report presents an analytic framework for evaluating the impact of comparative...
Commentary and Testimony Page

The Importance of Evidence, Value, Access and Innovation in 2016

Last year, in our 2015 Health Care Outlook published in Chain Drug Review, I highlighted the recent announcement by the U.S. Department of Health and...
Commentary and Testimony Page

NPC Comments on CMS' Proposed Changes to Protected Classes

March 7, 2014Marilyn B. TavennerAdministratorCenters for Medicare & Medicaid ServicesU.S. Department of Health and Human Services200 Independence...
YouTube Videos

Accountable Care Measures for High-Cost Specialty Care and Innovative Treatment

Tom Valuck, MD, MHSA, JD, partner, Discern Health, is a co-author of the white paper "Accountable Care Measures for High-Cost Specialty Care and...
YouTube Videos

Patients, Research and Access to Health Care

Myrl Weinberg, FASAE, CAE, president of the National Health Council, says that it's important to for individuals, especially those with chronic...
Blog Post

Can We Work Together to Ensure Patient Access to Treatments and Encourage Innovation?

Is it possible for all health care stakeholders to work together to develop solutions for containing costs that ensure patient access to care and...
Blog Post

The Shift to Value-Based Care: Balancing Quality Improvement with Patient Access

Over the last few years, there has been a significant shift throughout our health care system to move to a delivery and payment model known as value-...
Blog Post

#TBT: Restrictive Formularies & Potential Pitfalls

As part of our Throwback Thursday blog series, we’re taking a look at a topic that’s currently in the news and tagging it with previous research,...
Blog Post

NPC Comments on ASCO Value Framework

The American Society of Clinical Oncology (ASCO) on Monday released a conceptual framework--“A Framework to Assess the Value of Cancer Treatment...

Designing Successful Bundled Payment Initiatives

The National Pharmaceutical Council led a study that identified three principles intended to...

Consumer-Directed Health Plans: Pharmacy Benefits & "Better Practices"

On behalf of the National Pharmaceutical Council, Th

  •  
  • 1 of 6
  • >