Are Payers Ready, Willing, and Able to Provide Access to New Durable Gene Therapies?

Eric NormanArticles, FoCUS

Value in Health, June 2019
Jane F. Barlow, Mo Yang, and J. Russell Teagarden

Access to new gene therapies may be impacted by payer ability to absorb the cost of coverage. Variation exists in awareness of new gene therapies and level of incorporation of new costs into future plan coverage. The sustainability of current financing mechanisms varies by payer segment, profitability, and size; smaller plans and Medicaid are likely to be impacted first. Government reinsurance, commercial reinsurance, and stop-loss insurance backstop current reimbursement models, dampening the need for urgent action. The tipping point for action may be severe premium inflation in stop loss and reinsurance. Payers are open to innovative financing models that improve financial predictability and reward clinical performance.

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