Note: This story was updated on June 15, 2020, to clarify that the agreement allows for possible reimbursement for Prime’s health plan clients, not patients directly.
Prime Therapeutics has signed an agreement with EMD Serono that may provide financial compensation for its health plan clients if their members stop taking Mavenclad (cladribine) during the typical treatment period.
The level of financial compensation will depend on the rate at which multiple sclerosis (MS) patients discontinue Mavenclad or switch to another MS therapy over the typical two-year treatment course.
“We are pleased that an industry leader like Prime Therapeutics recognizes the value of covering Mavenclad. This innovative contract provides value-based payment upon patients discontinuing or changing therapies, which supports our patient-centric mission,” Robert Truckenmiller, head of Market Access and Customer Solutions, Fertility and Endocrinology at EMD Serono, said in a press release.
Mavenclad, developed and marketed by EMD Serono (known as Merck KGaA outside the U.S. and Canada), is an oral, short-course therapy approved by the U.S. Food and Drug Administration for relapsing-remitting MS and active secondary progressive MS. It is designed to be given in two treatment courses over two years. Each treatment course is approximately two weeks, spaced one month apart.
It works by lowering the number of immune cells in the patient’s bloodstream that are the cause of nerve degeneration in MS. Due to its safety profile, Mavenclad is typically recommended for those who failed to respond, or were unable to tolerate, other MS treatments.
The medication’s prescribing information contains a boxed warning for cancer and an increased risk of teratogenicity, or toxicity to a developing fetus, as well as disclosure of the most common side effects associated with its use, including upper respiratory tract infections, headaches, and low white blood cell counts.
Based on real-world data, Prime determined that MS therapies are some of the most expensive medications prescribed to its insured members. The agreement struck between Prime and EMD Serono seeks to improve Mavenclad’s cost-benefit value and patient experience.
“Prime’s health outcomes data on members clearly show us which drugs provide the highest value relative to their cost. We build our value-based agreements using a patient-centered approach that seeks to lower cost of care while improving the quality of therapies Blue Plans pay for and their members receive,” said Kelly McGrail-Pokuta, vice president of pharmaceutical trade relations at Prime.
According to the data, health insurance companies should consider establishing value-based agreements for more expensive therapies to help lower their costs, as well as developing clinical programs to improve their use, as prescribed.
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