In a recent move that garnered considerable attention, Express Scripts, one of the largest pharmacy benefit managers (PBMs) in the US, announced a plan that would link the price of some cancer drugs to their real-world performance.¹ Although this isn’t the first time that an alternative pricing model for drugs has been suggested, the timing of the announcement is telling. After years of concern over mounting drug prices, payers and PBMs are becoming increasingly assertive regarding products whose costs aren’t perceived as in line with perceived performance – a trend that shows no signs of slowing down in the current healthcare environment.

Because of the intense focus across the healthcare industry on delivering “better outcomes at lower cost,” it’s not surprising that the pressure to use cost containment measures for drugs and therapies – including risk sharing agreements (RSAs) – continues to increase. In fact, RSAs (also known as risk-based contracts) and related schemes are already being used in a number of foreign markets – including the U.K. and Italy – as a way of controlling costs. As an added benefit, RSAs can serve to “hedge” reimbursement decisions, allowing payers to respond to patient and physician pressure for new and more costly drugs while also attempting to mitigate the uncertainties around these products.