Webinar 2: U.S. Lessons Learnt from Kymriah & Luxturna?
In the second of three webinars, P4A is focussing on the US environment for gene therapies. Single application cell and gene therapies in the US face health insurance challenges driven by a short-term focus, disconnection between price reporting and outcomes value, and complex distribution models. To mitigate these challenges, health insurers and gene therapy companies are exploring different payment models to help improve access and spread costs.
Following Kymriah’s approval, Novartis announced a collaboration with the Centres for Medicare and Medicaid Services wherein children and young adults would face no charge if the patient was unresponsive to the treatment within a month.
Other models include a staggered payment structure with a fixed upfront payment at the time of treatment origin followed by regular instalments until the bill is covered or the disease returns.
In January 2018, Spark Therapeutics announced payer programs for Luxturna that were designed to overcome cost and value-based challenges. These include:
- Outcomes-based rebate arrangement with a long-term durability measure
- Innovative contracting model under which payments would be made over time
We will be exploring the validity of these programs from two perspectives – health insurance plans and gene therapy manufacturers.
Key topics to be discussed at the webinar are:
- Is it important to have alternative mechanisms and payment models for gene therapy?
- What are the key lessons learnt from Spark’s payer programs?
- Payer perspective
- Manufacturer’s perspective
- What are the key considerations for patient assistance and payer programs by gene therapy companies?
- What are the relevant and appropriate mechanisms?
