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October 2017

Tying Reimbursement to Outcomes Is an Ideal Strategy for PCSK9 Inhibitors

Author Affiliations
  • 1Cardiology Division, Massachusetts General Hospital, Boston
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
  • 4RAND Corporation, Santa Monica, California
  • 5Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 6Department of Medicine, Massachusetts General Hospital, Boston
  • 7National Bureau of Economic Research, Cambridge, Massachusetts
JAMA Cardiol. 2017;2(10):1063-1064. doi:10.1001/jamacardio.2017.2959

Pay-for-performance programs, which seek to better align incentives between insurers and clinicians, are increasingly being used to improve quality without necessarily increasing spending. For example, under Medicare’s hospital value-based payment program, reimbursements are based partly on hospital performance on measures of quality, satisfaction, and mortality rates.

We have not seen similar progress in reforming reimbursements for prescription drugs. Recent approvals of expensive medications targeting common cardiovascular diseases—including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, a new class of monoclonal antibody lipid-lowering therapy—provide an opportunity to use innovative reimbursement approaches to foster better accountability for patient outcomes.