Contract for multiple sclerosis treatment ties payments to patient outcomes and drives affordability for Colorado taxpayers
FOR IMMEDIATE RELEASE
January 25, 2023
Denver, CO - Today, the Colorado Department of Health Care Policy & Financing (Department) announced it has entered into a value-based contract with Genentech for Ocrevus® (ocrelizumab), an infused medicine used to treat primary progressive and relapsing forms of multiple sclerosis (MS).
The Department is committed to addressing rising drug costs and improving health outcomes while preserving function and quality of life for members with MS through this new contractual agreement.
With the introduction of new and innovative treatments, prescription drug costs have continued to increase for Health First Colorado (Colorado’s Medicaid program), creating a significant impact on program expenditures. As a result, the Department will continue to enter into contracts that hold drug manufacturers financially accountable to the clinical outcomes demonstrated by real world evidence. These contracts help deliver savings to taxpayers in the form of additional manufacturer rebates if drug therapies do not meet defined clinical health outcomes for the Health First Colorado members using them. Last March, the Department announced value-based contracts with Novartis pharmaceuticals for its Entresto and Zolgensma drug therapies.
“Prescription drug costs are the leading contributor to rising health care costs across the United States and here in Colorado. Less than 2% of our program prescriptions are so expensive, they are driving more than 50% of our prescription drug expenditures,” said Kim Bimestefer, executive director for the Department. “This value-based contract with Genentech demonstrates our shared goal of improving patient access and health outcomes while driving manufacturer accountability and overall affordability within the Medicaid program.”
This value-based contract will measure the health outcomes of Medicaid patients starting or already taking Ocrevus. The manufacturer will provide supplemental rebates to the Department if qualifying members’ health is not maintained or improved using this therapy. The health measurements are based on predetermined criteria for MS.
The Department intends to enter into more value-based arrangements with pharmaceutical manufacturers who are willing to partner and collaborate on accountability for their role in improving patient health outcomes as well as driving health care affordability. Manufacturers are encouraged to send their inquiries to hcpf_Colorado.SMAC@state.co.us.
About the Colorado Department of Health Care Policy & Financing: The Department administers Health First Colorado (Colorado's Medicaid program), Child Health Plan Plus, and other programs for Coloradans who qualify. These health care programs now cover about one in four Coloradans. For more information about the Department, please visit hcpf.colorado.gov.