State makes deals on pricey drugs

In the two months since Oklahoma got the right to negotiate pay-for-performance deals with drug makers, operators of the state’s Medicaid program have signed off on four, including one where the state will pay less if patients stay on the same drug.

The first deal, for an anti-seizure drug named Fycompa, was unveiled in October. Since then, the state has made agreements for an antibiotic called Orbactiv and three antipsychotic drugs: Aristada, Invega Sustenna and Invega Trinza. Sustenna and Trinza are different formulations of the same drug, given monthly or every three months.

The Oklahoma Health Care Authority, which oversees the state’s Medicaid program, declined to outline any financial expectations it has for the deals, and the pharmaceutical companies said they didn’t want to tip off competitors about the terms they negotiated.

The authority removed “some restrictions” that patients try less expensive drugs before using Fycompa or Orbactiv, spokeswoman Katelynn Burns said. The antipsychotics already were easily available, she said.

In retail outlets, a syringe of Aristada sells for about $2,400, while the same amount of Invega Sustenna costs about $1,700 and Invega Trinza can cost $2,600. A vial of Orbactiv sells for about $1,000, while Fycompa is a relative bargain at around $475 for a 30-day supply. State Medicaid programs receive rebates, so the state likely is paying less, though the authority wouldn’t say how much less.

In the case of Fycompa, the state will get rebates if drugs fail to improve patient outcomes by as much as the deal specifies. It has a different arrangement for Aristada. Maker Alkermes will charge the state a lower price on the drug if patients who have schizophrenia consistently get the injections, which last for about a month.

“Long-term adherence to treatment is critical for improving outcomes for patients with schizophrenia; however, a significant percentage of patients living with schizophrenia are unable to follow their prescribed regimen,” said Matthew Henson, spokesman for Alkermes. “Recognizing this, the State of Oklahoma is working to encourage patients to adhere to their prescribed treatment.”

Janssen Pharmaceuticals, which makes the two Invega antipsychotic drugs, promoted them as a way to delay “relapse,” when patients with schizophrenia experience uncontrolled symptoms. While the injectables are significantly more expensive than antipsychotics given in pill form, Janssen argues systems can save money overall by reducing the cost of caring for people in crisis.

“Delaying relapses, such as incarceration and hospitalization, can bring significant economic benefits to the health care system,” said Kristina Chang, communication leader for Janssen’s neuroscience and infectious disease unit. “We continue to pursue innovative contracts that can potentially broaden patient access to important medicines.”

Melinta, which makes the antibiotic Orbactiv, declined to discuss specifics about its deal, but said using it as a first treatment will benefit patients with certain types of skin infections, such as cellulitis, infected wounds and large accumulations of pus in the skin.

“We believe that this agreement has the potential to provide a mutual benefit to Melinta, the Oklahoma Medicaid program and, most importantly, the patients who will have easier access to Orbactiv,” said Lindsay Rocco, who does public relations for Melinta.