Are Payers Ready to Address the Financial Challenges Associated With Gene Therapy?

While gene therapies hold the promise of substantial benefits, “some patients will face barriers accessing them due to the nature of the clinical intervention, the characteristics of the U.S. insurance system, and the interaction between the two.”

A new article published on the Health Affairs Blog explores these tensions in our health care system via online market research with payers and highlights a few proposals to address these concerns. The article, written by the National Pharmaceutical Council and the Analysis Group, found that when it comes financing these innovative and life-changing therapies, the implications and risk factors faced by payers vary according to their size.

Many payers will require performance guarantees, or assurance that the therapy works effectively in patients before payments are made; consider using alternative payment models, depending on the economics and design of the health plan; and are interested in long-term payment arrangements but have discomfort with patient portability payment options, calling those a “deal-breaker.” The article notes that both biopharmaceutical manufacturers and payers will face challenges as they explore new payment models for gene therapies, but they “have an opportunity to break the limitations of the current mold, and ensure patient access to a new generation of transformative therapies.”