Novartis agrees to pay-for-performance agreements with insurers to cover heart failure drug

Novartis has entered into a pay-for-performance agreement with Cigna to cover sacubitril/valsartan (Entresto), a twice-daily oral medication to treat patients with heart failure and reduced ejection fraction.

Aetna also signed a value-based agreement with Novartis based on the drug having similar results as shown in clinical trials, according to a Reuters report.

The FDA approved sacubitril/valsartan in July under its priority review program. The drug is typically used with beta blockers to reduce the risk of death and heart failure hospitalization.

Under the contract with Cigna, Novartis’s reimbursement will be tied to the drug’s effectiveness at improving patients’ health, particularly at reducing heart failure hospitalizations. Sacubitril/valsartan will be a preferred brand drug but will also be subject to a prior authorization review.

“Competitive drug prices are important, but equally so is ensuring that customers’ medications are actually working as, or better than, expected,” Christopher Bradbury, senior vice president of integrated clinical and specialty drug solutions for Cigna Pharmacy Management, said in a news release. “Outcomes-based contracts require that prescription medicines perform in the real world at least as well as they did during clinical trials and are a valuable tool for improving health and managing costs. When pharmaceutical companies stand behind the performance of their drugs through these kinds of contracts, we can deliver the most value to Cigna's customers and clients for the money they are spending.”

The Institute for Clinical and Economic Review (ICER), a nonprofit healthcare research organization, released a report last year that found the $4,560 wholesale acquisition cost of sacubitril/valsartan would not save payers and patients money. However, ICER said the drug was cost-effective because it increases the average life expectancy for patients and decreases the number of congestive heart failure hospitalizations.

In December, an actuarial analysis published in the New England Journal of Medicine found that patients who receive sacubitril/valsartan might have an increased life expectancy and reduced risk of death from cardiovascular causes or hospitalization for heart failure compared with patients who take enalapril.