Leaders Proposed New Value-Based Contracting Models
Specialty pharmacy operators are exploring population-based models to manage the financial risks of high-cost gene therapies.
Updated on Sept. 28, 2026 in Healthcare
Live Poll
Should drug manufacturers be held financially liable if high-cost therapies do not improve patient outcomes?
At the inSPire2026 conference in National Harbor, Maryland, industry stakeholders discussed shifting away from single-product contracts for high-cost cell and gene therapies. This strategic shift aims to address the financial complexities inherent in specialty pharmacy medication management.
Why it matters
The rise of expensive cell and gene therapies, combined with regulatory pressures from the 340B Drug Pricing Program and Medicare price negotiations, has made traditional contracting models increasingly unsustainable. These pressures discourage manufacturers from assuming financial risk, necessitating new reimbursement frameworks.
Panelists identified multiple proposed population-based contracting models as alternatives to current single-product agreements. The specific adoption rate of these models remains unknown, as do the ultimate financial impacts for specialty pharmacy providers.
The players
Chester Good
The senior medical director of the Center for Value-Based Pharmacy Initiatives at UPMC Health Plan.
UPMC Health Plan
An integrated health care delivery system that manages health coverage and provides pharmacy benefits.
The details
Specialty pharmacies are uniquely positioned to lead this shift because they maintain more frequent patient contact than prescribing clinicians. By utilizing this direct relationship to collect patient-reported outcomes, pharmacies can provide the empirical data necessary to measure therapy efficacy. This data serves as the foundation for value-based agreements that tie payment to health outcomes rather than just the volume of drugs dispensed.
Timeline
The inSPire2026 conference took place in 2026.
Market Landscape
This shift in contracting strategy follows a pattern set by the 340B Drug Pricing Program and Medicare drug price negotiations. These regulatory frameworks have fundamentally altered the incentive structures for pharmaceutical manufacturers and pharmacy benefit managers.
Specialty pharmacy operators should evaluate how they collect and report patient outcome data to ensure they are prepared for outcomes-based payment models. Business leaders should also monitor whether upcoming policy changes further incentivize these population-based contracting shifts.
The takeaway
The move toward population-based contracting represents a vital strategic shift for managing the high costs of emerging genetic therapies. Operators should track the efficacy of patient-reported outcome metrics as these data points will likely dictate the next generation of pharmacy contracts.
Further reading
For broader insight into pharmacy payment trends, visit the Healthcare section.
Source note: This article includes information reported by Ajmc.
Live Poll
Should drug manufacturers be held financially liable if high-cost therapies do not improve patient outcomes?
