TABLE 3.

Participant Recommendations for Aligning Contract Types that May Evolve into a VBC

	Contract Types that May Evolve into a VBC
	Risk Sharing	Coverage with Evidence Generation	Shared Accountability Model	Bundled Service
Brief summary of contract requirements	Manufacturer charges less for the cost of therapy for patients or populations with suboptimal results or missed health outcomes	Manufacturer is financially liable or upside may be based on real-world evidence outcomes (e.g., from registries, active surveillance, claims)	Incorporates services that support a patient throughout their care transitions that aim to optimize their outcomes	Manufacturers offer additional patient services with the product
Key stakeholders	Payers, manufacturers, integrated delivery networks, future payers, employers, patients (potentially in the future)	Patients, advocacy groups, manufacturers, payers, health care providers	Manufacturers, providers, payers	Payers, manufacturers, specialty pharmacies
Key considerations	Level of complexity: Variable Appropriate for any therapeutic area Real-world evidence requirements Defined outcome (e.g., comparative, baseline and measurement, control group) Robust data (claims, EMR, labs) Readily available (engine-predictive analytics, dedicated personnel, shared service with athird party, academic, other) Example: For patients with diabetes receiving a medication, payers would pay more for lower A1c results and less for higher A1c results	Level of complexity: High Appropriate for medications/devices/diagnostics that are approved with limited evidence (e.g., following an accelerated drug approval process) Intermediate outcomes available but need long-term data Expanding indications Treatment areas may include specialty, oncology (especially accelerated approvals with less evidence), orphan drugs, emerging treatments Data generated may drive formulary placement and future management decisions Example treatment area: Duchenne muscular dystrophy or comparison of biologics vs. biosimilars	Level of complexity: Undetermined May be based on diagnosis, research and goals, tools/services/solutions Nonbranded tools or services/solutions may be developed for the broader marketplace and incorporated into the contracts Payers advance the service to the provider, and the provider drives patient outcomes and monitors Adherence-based outcome as a measure Example: Mobile health apps	Level of complexity: High Not viable in current marketplace due to legal and regulatory complexities (e.g., best price implications). Instead, services should be provided as a separate contract. “Suite of contracts” can achieve same aim Potentially narrows the eligible population Example treatment area: Diabetes

A1c = hemoglobin A1c; EMR = electronic medical record; VBC = value-based contract.