Resources for self-insured employers
Durable cell and gene therapies are here. Paying for Cures in the MIT NEWDIGS FoCUS Project is your source for thoughtful, thorough, and inclusive strategies to grapple with the emerging challenges of making them accessible to your team and sustainable to your company.
Paying for Cures: Framing the solutions
Precision Financing Solutions
Durable therapies create three financial challenges: Payment timing, therapeutic performance risk, and actuarial risk. The NEWDIGS FoCUS consortium has worked to address the need for new, innovative financing and reimbursement models for durable/potentially curative therapies in the US to ensure patient access and sustainability for all stakeholders.
Called Precision Financing Solutions, our innovative and evolving recommendations can help self-insured employers evaluate their risks and explore combinations of solutions to meet the challenges they face.
Payer perspectives on financing and reimbursing cures
The reimbursement of emerging one-time high-cost durable/potentially curative cell and gene therapies is likely to be a challenge for US payers. The pricing of currently approved treatments and the cumulative cost impact as pipeline agents are approved are likely to challenge payers’ ability to provide affordable health coverage.
We surveyed payers to understand their interest in considering new financing approaches, the potential priority and timing of their actions, and considerations for adoption.
Tracking the CAR-T Revolution
Chimeric antigen receptor and T-cell receptor (CAR-T/TCR) cellular immunotherapies have shown remarkable success in the treatment of some refractory B-cell malignancies, with potential to provide durable clinical response for other types of cancer.
In this paper, we look at all available FDA CAR-T/TCR clinical trials for the treatment of cancer, and analyze them with respect to different indications, targeted antigens, products, and originator locations.
Paying for Cures is an initiative of the FoCUS Project at MIT
FoCUS seeks to collaboratively address the need for new, innovative financing and reimbursement models for durable therapies that ensure patient access and sustainability for all stakeholders. This multi-stakeholder effort unites developers, providers, regulators, patient advocacy groups, payers from all segments of the US healthcare system, and academics working in healthcare policy, financing, and reimbursement.
FoCUS research and design
- Engaged cross-sector, multi-stakeholder group to identify challenges and cooperatively design sustainable solutions
- Analyzed drug pipeline to understand scale of the challenge
- Described system of “Cure Archetypes” and how different kinds of healthcare payers can support them
- Designed and served as a catalyst for Precision Financing pilots to test real-world application
MIT Center for Biomedical Innovation
Massachusetts Institute of Technology
77 Massachusetts Avenue
Cambridge, MA 02139