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Use of adherence monitoring in drug contracts tied to outcomes: put patients first

Bartholomew, Theodore, Naci, Huseyin, Robertson, Emma and Schmidt, Harald (2022) Use of adherence monitoring in drug contracts tied to outcomes: put patients first. BMJ (Clinical research ed.), 376. ISSN 1756-1833

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Identification Number: 10.1136/bmj-2020-062188


Healthcare payers, including NHS England, are making increasing use of outcomes based contracts for new drugs. Under these contracts payment for drugs is tied to real world effectiveness instead of a fixed price per unit. A typical agreement might entail a manufacturer either wholly or partially refunding drug costs if the agreed outcome threshold (cure, reduction in mortality, biochemical outcome) is not met. Although these contracts can facilitate access to new drugs when cost effectiveness is unclear, they present challenges with measuring outcomes and have potential for political and commercial conflict of interests. Patients’ adherence to drugs attains new importance in outcomes based contracts. Manufacturers may argue that suboptimal adherence is responsible for a poor outcome rather than ineffectiveness whereas payers may argue the opposite. Medication non-adherence is widespread with rates of up to 50% reported in hypertension, diabetes, asthma and cancer, and the reasons for it are complex and poorly understood. One way to help assess whether outcomes reflect effectiveness is to include a requirement for adherence monitoring in outcomes based contracts. This has clear measurement advantages for both manufacturer and payer, but whether it is in the interests of patients is unclear. We consider how outcomes based contracts and adherence monitoring might affect patients within a nationalised health system such as the NHS.

Item Type: Article
Official URL:
Additional Information: © 2022 BMJ Publishing Group Ltd
Divisions: Health Policy
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RM Therapeutics. Pharmacology
Date Deposited: 24 Mar 2022 14:27
Last Modified: 12 Jul 2024 21:27

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