Tuesday, April 23, 2019
PITTSBURGH, Pa. (April 23, 2019) — As part of its ongoing mission to get healthcare right, Highmark Inc. is targeting autoimmune diseases by designing a specialty pharmacy contract focused on improved health outcomes for affected Highmark members. Most recently, Highmark entered into an outcomes-based agreement with Takeda Pharmaceuticals for the medication Entyvio, their treatment for moderate to severe ulcerative colitis or Crohn's disease, in patients for whom other medications have not worked well enough.
As part of the agreement, Highmark members on Entyvio must advance from an "induction" phase into a "maintenance" phase, demonstrating therapeutic improvement. If the maintenance phase is not reached, and there are savings generated as a result of the medication not meeting the intended outcomes, Highmark will provide these back to customers based on their contract.
"Highmark is committed to innovative contracting solutions that focus on clinical results and drive members to products that will encourage better disease management and an overall better healthcare experience," said Sarah Marche, vice president of pharmacy services at Highmark Inc. "When Highmark works closely with pharmaceutical companies, like Takeda, that stand behind their treatments and results, we can better ensure members have the right tools and resources to embrace their health and improve the quality of their life."
Launched in January 2019, the contract is applicable for all commercial members in Highmark's national and core health insurance markets in Pennsylvania, West Virginia and Delaware.
"Takeda is deeply committed to producing innovative medicines and meaningful healthcare solutions that improve patient outcomes. We believe strongly in the value of Entyvio and the importance of therapeutic options for Inflammatory Bowel Disease (IBD). This innovative agreement with Highmark connects that value for patients directly to success with the therapy, bringing the patient, payer and Takeda together to focus on the most meaningful outcomes for everyone involved," says Rick Ascroft, SVP Managed Markets at Takeda.
According to the CDC, an estimated three million Americans suffer from IBD, whether Crohn's or ulcerative colitis. There is no cure for either disease, but symptoms can be managed through proper care.
This contract announcement is the latest milestone in Highmark Health's ongoing commitment to improve health outcomes for those diagnosed with autoimmune disorders. Last year, Allegheny Health Network (AHN), a Highmark Health company, opened the Autoimmunity Institute at West Penn Hospital in Pittsburgh. The first of its kind in the world, the Autoimmunity Institute combines multispecialty care with cutting-edge research, patient education and advocacy to advance the treatment of autoimmune diseases and accelerate discovery of a cure.
Part of the AHN Medicine Institute, led by Susan Manzi, MD, MPH, the Autoimmunity Institute collaborates with Highmark to help ensure the best end-to-end health experience for patients and members.
"We need to change the way health care is delivered in the United States. The experience for patients and their families is not optimal and the cost is too high. We have to move away from focusing only on treating diseases, to addressing all of the needs of the people impacted by these diseases, such as mental health and social determinants of care like transportation, cost, housing and other potential barriers to good health outcomes. We are doing that at AHN with support from Highmark Health," said Dr. Manzi in a recent interview.
The value-based contract with Takeda continues Highmark's streak of designing and implementing pharmacy agreements that focus on improved health outcomes for members and ensuring the medications that they are using are working for them. In 2018, Highmark entered into value-based contracts with pharmacy manufacturers Boehringer Ingelheim and AstraZeneca for the treatment of COPD and diabetes, respectively.
Highmark Inc. and its health insurance subsidiaries and affiliates collectively are one of America's largest health insurance organizations and together with its Blue-branded affiliates, collectively comprise the third-largest overall Blue Cross and Blue Shield-affiliated organization in the country based on capital. Highmark Inc. and its affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve approximately 4.6 million members and hundreds of thousands of additional individuals through the BlueCard® program. Its diversified businesses serve group customer and individual needs across the United States through dental insurance, vision care and other related businesses. Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit www.highmark.com.
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