Value in Health
June 2019 Volume 22, Issue 6, p619-750
Are Payers Ready, Willing, and Able to Provide Access to New Durable Gene Therapies?
Jane F. Barlow, Mo Yang, J. Russell Teagarden
Published online: May 16, 2019
:: Understanding the payer perspective and the challenges they face in delivering affordable healthcare coverage while ensuring access to medical innovation is critical to the sustainability of research and development of new cures.
:: Variation exists in payer awareness of and ability to absorb the cost of new durable gene therapies. Public payers are constrained by regulatory requirements affording them less flexibility than other payer segments to actively manage these new costs.
:: Payers are open to new financing mechanisms, favoring performance-based contracts and risk pooling strategies to absorb the aggregate impact of new market entrants and extended indications for high cost durable therapies over the next 3 to 5 years.