UPMC Health Plan and Boehringer Ingelheim Announce Innovative, Value-Based Agreement

PITTSBURGH, Sept. 27, 2018 /PRNewswire/ -- The UPMC Health Plan announced today the initiation of a value-based contract with Boehringer Ingelheim effective 1/1/2019 for Jardiance^® (empagliflozin), an oral type 2 diabetes medicine also indicated to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease. The goal of the contract is to align the incentives of the manufacturer, Boehringer Ingelheim, with the UPMC Health Plan, and will link reimbursement of the drug to costs associated with clinical outcomes in the real-world population. In a first-of-its-kind contract, reimbursement for the medication will be linked to total costs of care for all people with diabetes treated. Previous contracts for Jardiance measured costs only in those with existing heart disease. Jardiance is a product in the Boehringer Ingelheim and Eli Lilly and Company diabetes alliance portfolio.

"We think this type of contract really changes the paradigm around how we pay for medicine. Rather than the standard approach which focused solely on price negotiations, we are now paying for results, to encourage the insurer and the manufacturer to be on the same page – and that page is focused on the health of the patient," said Chronis Manolis, RPh, Chief Pharmacy Officer of UPMC Health Plan.

Such contracts have been hindered by several barriers, including limited collaboration and consensus between prescribers and payers and difficulty measuring value (due to fragmented and limited data sets and lack of consensus on measures).

Jardiance was selected by clinical and academic experts at UPMC because it has been shown to improve the management of blood sugars and reduce cardiovascular death in adults with type 2 diabetes and established cardiovascular disease and is an important treatment in the management of the disease. Jardiance is also currently the only SGLT2 inhibitor recommended in the ADA 2018 Standards of Medical Care in Diabetes for reducing the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease. Cardiovascular disease is the number one cause of death for people with diabetes.

"Through this unique partnership with UPMC Health Plan, we have the potential to systematically change the way people with type 2 diabetes are treated," said Christine Marsh, vice president, Market Access, Boehringer Ingelheim Pharmaceuticals, Inc. "This agreement will also help increase access for adults with type 2 diabetes and established cardiovascular disease who stand to benefit from Jardiance and its life-saving cardiovascular benefit. We are confident in its ability to reduce overall cost of care for this population."

William Shrank, MD, Chief Medical Officer of UPMC Health Plan notes, "We think this can be a central strategy to improve value for our members. UPMC will leverage strengths from the Health Plan, the Health System, and University of Pittsburgh academic clinical experts to promote optimal diabetes management, better medication adherence and to support healthier lifestyles - all with the goal of better health outcomes and lower total health care costs. We hope that by sharing results of our efforts, we can serve as a testing ground for the rest of the nation."

UPMC Health Plan, part of the broader UPMC Integrated Delivery and Finance System will engage all stakeholders to create a wraparound care model to ensure maximization of treatment and removal of many of the traditional barriers to care.  Leveraging our internal clinical resources, integrated clinical collaboration model, our Value Based provider reimbursement construct and award-winning member services, the goal is to create an environment where our members outcomes can be maximized.

The development of the value-based contract was led by the Center for Value-Based Pharmacy Initiatives, the UPMC Insurance Services Division's non-for-profit research group and benefited from engagement of leaders across UMPC, an integrated payor and provider. Clinical and academic leaders from University of Pittsburgh and UPMC collaborated around outcomes to measure, clinical leadership supported adjustments in the formulary, patients and their caregivers were surveyed to be sure the agreement reflects their priorities, and UPMC Health Plan and Boehringer Ingelheim developed the contract collaboratively. Dr. Shrank and Mr. Manolis both have leadership roles in Center 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, 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.

SOURCE UPMC Health Plan

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