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Heart Failure | Access and Reimbursement | US | 2018

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Market Outlook

This report examines the market access factors that influence the success of therapies for chronic heart failure (CHF), with a special focus on payers’ and cardiologists’ reactions to the trend in outcomes-based contracts (OBCs). OBCs require pharmaceutical manufacturers to justify the use of expensive new therapies. Novartis, for example, entered into OBCs with several managed care organizations (MCOs) for its heart failure drug Entresto. We asked MCO pharmacy and medical directors about their experience with OBCs and cardiologists about their involvement in such contracts.

Questions Answered:

  • Are MCOs embracing risk-based contracting strategies for cardiology drugs and Entresto in particular? What is the outlook for this strategy for emerging heart failure therapies?
  • What are the results, if any, of MCOs’ OBCs for Entresto? What performance benchmarks are most important in an OBC for heart failure drugs?
  • How do OBCs affect cardiologists’ prescribing decisions? How will MCOs approach the coverage of drugs that will be indicated for heart failure with preserved ejection fraction (HFpEF)?
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