OBJECTIVES: The objectives of this study were to examine current OBC activity in the USA, including risk sharing, therapy areas most suited for OBC and factors that could drive consideration of OBC offerings.

METHODS: An online survey was conducted with 48 active payers (18 medical and 30 pharmacy directors). All respondents made new drug formulary coverage decisions and were chairing or advising their Pharmacy & Therapeutics (P&T) committees.

RESULTS: Respondents managed a total of 140M medical and 300M pharmacy lives. 52% payers (1/3^rd lives in the study) reported having OBC contracts in place, but they do not apply to all their lives. 48% payers (~2/3rds of lives in study) do not have any OBCs. Of those, 48% of payers anticipated having them in the future and 52% would never have it. 64% of payers' rated diabetes, cardiovascular, rare diseases, and hemophilia to be most attractive for OBC. Most payers (60%) that have OBCs have them for less than 10 products. ZYNTEGLO®, Trulicity®, reSET-O®, ENTRESTO®, ONPATTRO®, AVONEX®, VUMERITY®, and TYSABRI® are some examples. Majority of OBC contracts include risk sharing. Other arrangements include measures such as adherence, biomarkers, capped pricing, insurance riders, stop loss coverage, non-performance etc.

CONCLUSIONS: Results indicate that payers are interested but do not have OBCs for most of their plan lives due to a lack of measurable outcomes and minimal risk sharing. While some express a plan to increase in the future, not all payers will be willing to adopt unless they are easy to interpret and risk sharing from manufacturers is expanded.