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Health plans expand use of outcomes-based drug contracts with PBMs: Study

Posted On: Apr. 11, 2023 10:05 AM CST

More than half of health plans used an outcomes-based contract with prescription benefit managers in 2022, with most preferring contracts with both claims-based and clinical outcomes, an Avalere Health survey found, reports Healthpayer Intelligence. Outcomes-based contracts are agreements between health plans and PBMs that tie prescription drug reimbursement to clinical quality or utilization outcomes. Avalere found that 58% of respondents were in at least one outcomes-based contract in 2022.