Monday, July 5, 2021

New White Paper Addresses "Emerging Market Solutions" For Highest-Cost Gene Therapies

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.

For Medicare and CAR-T therapy, see Avalere in September 2020 here, with an update in March 2021, 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.