Patients and caregivers are key stakeholders in the development of system-wide, implementable precision financing models for durable and curative therapies. Patient and caregiver challenges are generally assumed to be primarily … Read More
Incorporation of Value-Based Payment Agreements into the Calculation of Medicaid Drug Rebates
Value-Based Payment (VBP) agreements will play an important role in mitigating uncertainty in durable therapies, where it is unclear whether a large upfront payment is justified based on limited clinical … Read More
Clinical trials and investment trends for novel CAR-T and TCR therapies
Compared to small-molecule therapies, the nature of CAR-T/TCR therapies is such that they can be diversified with lower probability of failure in the clinic. Many companies and academic entities are … Read More
Model Contracts for Innovative Oncology Therapies
When there is substantial uncertainty about a new product’s expected value, stakeholders may have strong reasons to consider performance-based contracts. One of the hardest tasks in crafting such contracts is … Read More
Role of COE networks in curative cellular oncology therapies
COE networks currently play an important role in the delivery of care for specialized service lines, including but not limited to solid organ transplantation (SOT), hematopoietic cell transplantation (HCT) and … Read More
Stop-Loss Insurance or Reinsurance for Multiyear Contracts
In previous Research Briefs, we have discussed challenges faced by payers when contemplating using multiyear performance-based contracts. In this brief, we extend the discussion to include additional difficulties that may … Read More
Impact of Patient Mobility on Annuity/Performance-Based Contracting
Spreading payments over time for durable or curative therapies can provide a better alignment between benefits and costs, but creates challenges when patients switch insurance coverage during the contract term. … Read More
Orphan Reinsurer Benefit Managers (ORBMs)
An Orphan Reinsurer Benefit Manager (ORBM) could address the financial challenges (payment timing, therapeutic performance risk, actuarial risk), created by durable/potentially curable gene and cell therapies especially for smaller insurers … Read More
Impact of Actuarial Risk on Health Plans
The uncertain number of patients likely to be treated with an expensive novel therapy (actuarial risk) could represent a major financial issue for some payers. In this brief, we will … Read More
Designing Precision Financing for Cures
Designing Precision Financing for cures can be informed by a framework that tailors solutions to the three financing challenges of actuarial risk, performance risk and payment timing based on the … Read More