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US Private Payers Could Build Evidence On Alzheimer’s Drugs With Outcomes-Based Contracts

 
• By Cathy Kelly

Value-based contracting advocate Michael Sherman suggests creating an ‘enormous risk-based agreement as an industry’ between commercial payers and manufacturers of Alzheimer’s drugs that would condition reimbursement on achieving certain clinical endpoints.

Alzheimer's brain money
Payers Wary Of Biomarker-Driven Approvals For High-Cost Drugs • Source: Nielsen Hobbs; the Pink Sheet | Alamy images

Private payers could adapt Medicare’s proposed coverage with evidence development approach to Alzheimer’s drugs by agreeing to pay for them only if they achieve specified improved outcomes on cognition, Point32Health chief medical officer Michael Sherman suggested during the AHIP National Conference on Health Policy and Government Programs on 17 March.

“If there is legitimate uncertainty” about whether a drug has a clinical benefit, “but a lot of pressure to cover...

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