Caucus Seeks Views on Value-Based Contracting for Insulin

Washington, DC – The co-chairs of the Congressional Diabetes Caucus, Rep. Diana DeGette (D-CO) and Rep. Tom Reed (R-NY), have released a bipartisan request for stakeholders to provide information about whether health plans can pay for insulin based on how well the particular drug product works for patients.

DeGette and Reed have issued a Request for Information (RFI) into whether value-based contracting could be applied to insulin. Value-based contracting encompasses a number of different possible payment arrangements where reimbursement is tied to the achievement of certain pre-set goals.  For example, these arrangements could reimburse for drugs based on patient outcomes or a drug’s efficacy on different indications. They could also limit costs to a negotiated threshold or focus on a specific subset of patients. During their initial stakeholder meetings this summer, several groups argued that value-based contracts could hold promise for lowering cost burdens on patients who need insulin. This RFI is a follow-up to those conversations.

“We’re in the midst of a long-term inquiry into insulin costs and pricing that involves a variety of stakeholders from patient advocates to the major drug manufacturers. The goal is to explore all potential avenues that could make this life-saving medication more affordable for patients,” DeGette said. “Stakeholders and experts are telling us that innovative value-based contracts could be one tool to provide relief for patients. But we don’t know much about how these contracts are actually used in practice, and would like to learn more.”

“I am committed to providing cost relief to diabetes patients,” Reed said. “Since the cost of insulin has skyrocketed over recent years, it has become a priority of the Diabetes Caucus to find answers to the insulin price problem. As co-chair, I am interested in finding how value-based contracts would potentially reduce the cost of insulin.”

Stakeholders are asked in the RFI to address any of a number of questions, or to submit other information that they believe could be helpful. The questions include:

·         How does your organization define “value-based contracts”?    

·         Please describe how value-based contracting might work in the context of insulin.  You can provide examples of current contracts or hypothetical future contracts.

·         How common are value-based contracts for insulin?

·         Please describe any regulatory or statutory barriers to value-based contracting for insulin.

·         Please describe any operational or administrative barriers to value-based contracting for insulin.

·         To what extent is value-based contracting for pharmaceuticals being tested in government health care programs?

Stakeholders are asked to provide their input by December 15, 2017 to Insulin.Inquiry@mail.house.gov.