Part 2: U.S. Lessons Learnt from Kymriah & Luxturna?

Webinar description

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.

In January 2018, Spark Therapeutics announced payer programs for Luxturna that were designed to overcome cost and value-based challenges. These include:

  1. Outcomes-based rebate arrangement with a long-term durability measure
  2. 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 discussed at the webinar included


Sophie Schmitz

Managing Partner at P4A
Sophie is a leading expert on rare diseases and orphan drugs. She is heavily involved in advising orphan drug clients on price and market access strategies, with the ultimate goal of optimizing their launch. In a 20-year career span, Sophie has worked in various pharmaceutical therapy areas and medical devices focusing on key product launches in both strategic planning & implementation.

Dr Edmund Pezalla

CEO, Enlightment Bioconsult and former VP for Pharmaceutical Policy and Strategy, Aetna
Edmund is an innovator in payer strategy for pharma and device manufacturers. As VP for Pharmaceutical Policy and Strategy in Aetna, he developed and coordinated strategy for pharmaceutical evaluation and coverage across both the medical and pharmacy benefit, created Aetna’s framework for innovative contracts, and developed Aetna’s public policy positions on drug and device coverage. He is active as a payer expert on a number of policy working groups including the New Drug Development Paradigm Project at MIT and was previously a Scholar-in-Residence at Duke-Margolis Health Policy Center in Washington, DC

Prasun Subedi

Senior Director at Center for Health System Innovation and Leadership Patient and Health Impact, Pfizer