We've heard much in the CAR-T era of how payers might handle extremely expensive therapies (e.g. $250K-$1M). Here's a new entry point and white paper review.
The consultancy Real Endpoints has a news announcement that links one of its work productgs to a white paper at the MIT "NEWDIGS" program. See Real Endpoints here. See the MIT program, "New Drug Development Paradigms" (NEWDIGS) - here. See their peer-reviewed publications here. See their white papers and research briefs here.
And find the new 14-page white paper here.
- It's branded FOCUS - Financing and Reimbursement of Cures in the US.
- See also the webpage for the MIT "Paying For Cures" program, here.
- See also the MIT "Center for Biological Innovation" - here, which is co-branded with the white paper.
For the FOCUS White Paper, the MIT program surveyed 12 companies (payers, PBMs, etc) with a basket of 16 drug services, answering 32 questions for MIT.
Products fell in 4 categories - (1) payer stop loss or carve-out solutions; (2) contract negotiation and data services; (3) contract negotiation services, and finally (4) "financial warranty services."
|click to enlarge|
See partial screenshot of their taxonomy of risk, cost, administration, and provider-facing services:
|White paper, page 9|
See also an open access 2021 paper by Latimer et al., Challenges in valuing and paying for combination regimens in oncology: Multi-stakeholder international workshop, here. (Also open access is Ronco et al., 2021, here.) See an earlier 2018 report on new horizons for CAR-T financing by ICER, here.
In the same vein, see also an open access trade journal article, "Medicare braces for expanded use of high cost CAR-T therapy," March 2021, Lewis, here. See a June 2021 article, Anderson, "Payers create CAR-T approval systems as adoption increases," (email registration required), here.