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Ned Schano
UPMC Health Plan

UPMC Health Plan and Biogen Announce Groundbreaking Value-Based Agreement for Multiple Sclerosis Treatments

Value-based contract for Tecfidera® (dimethyl fumarate) and Avonex® (interferon beta-1a) is first-of-its-kind to link drug reimbursement to patient-reported outcomes

PITTSBURGH (Nov. 14, 2019) – UPMC Health Plan announced today that it has entered into a value-based agreement with Biogen for Tecfidera® (dimethyl fumarate) and Avonex® (interferon beta-1a), two specialty medications used to treat patients with relapsing forms of multiple sclerosis (MS). In this first-of-its-kind contract, reimbursement provided by the drug manufacturer, Biogen, to UPMC Health Plan will be linked to MS patient-reported measures of disability progression in a real-world population.

Previous value-based contracts for MS medications have connected payment to surrogate clinical indicators derived from claims and electronic health record data, such as MS-related emergency department visits, hospitalizations, medication adherence, and relapse rates.

However, a recent study conducted by the UPMC Center for Value-Based Pharmacy Initiatives, the UPMC Insurance Services Division’s non-profit research group, found that a panel of key MS stakeholders, including patients, providers, caregivers, payers, pharmaceutical manufacturer representatives, and pharmacy benefit manager representatives, unanimously ranked “worsening physical disability” as one of the most meaningful MS outcomes.1

“This new contract continues the innovative work that we are leading at the UPMC Center for Value-Based Pharmacy Initiatives to change the paradigm around how we pay for medications by utilizing outcome measures that clinically and financially align all of our stakeholders,” said Chronis Manolis, RPh, chief pharmacy officer at UPMC Health Plan. “By incorporating evidence-based findings into contract development and by including a patient-reported outcome that is most valued by our members, stakeholders, and providers, we move further into true risk-based contracting.”

As an integrated delivery and finance system, UPMC is uniquely positioned to administer and analyze patient-reported clinical assessments of disability. UPMC Health Plan and collaborating specialty pharmacy partners also provide “whole-person” wraparound care services to support the needs of members such as addressing lifestyle changes to improve outcomes, answering questions regarding medications to improve adherence and assess patient wellness, and improving access to innovative therapies with the overall goal of improving MS patient outcomes while reducing costs.

“This agreement with UPMC Health Plan connects the value of Biogen’s therapies to the real-world outcomes of MS patients. We are grateful to UPMC for their collaboration that will help to ensure access to our therapies for people living with relapsing forms of MS with the aim of supporting a more sustainable and affordable healthcare system,” said Alisha Alaimo, president of Biogen, U.S. organization.

Chester “Bernie” Good, MD, MPH, FACP, senior medical director for the UPMC Center for Value-Based Pharmacy Initiatives notes that “Our ultimate goal is to mitigate disability progression in our members with MS and to help them maintain active, healthy lives. Both Tecfidera and Avonex are important medications in the treatment of relapsing forms of MS. We are excited to collaborate with Biogen to create a value-based agreement that recognizes the importance of these medications for our members and our physicians.”

The development of the value-based contract was led by the UPMC Center for Value-Based Pharmacy Initiatives and benefited from the engagement of leaders across UPMC, an integrated payer and provider. Mr. Manolis and Dr. Good are nationally recognized experts in pharmaceutical outcomes research, pharmacy practice, progressive payment models, and managed care leadership.

1. Swart et al. Determination of Multiple Sclerosis Indicators for Value-Based Contracting Using the Delphi Method. J Manag Care Spec Pharm, 2019 Jul;25(7):753-760.


About UPMC Insurance Services Division

The UPMC Insurance Services Division is owned and operated by the 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 3.5 million members. For more information, visit www.upmchealthplan.com.