Pharmaceutical Executive, January 27, 2019 Trusheim, Jane Barlow Russell Teagarden Mark Gene therapies and cellular treatments create multiple financial challenges for US healthcare payers beyond price. The work of the … Read More
Precision Financing Solutions for Durable / Potentially Curative Therapies
The NEWDIGS FoCUS consortium of multiple stakeholders (payers, providers, patient advocacy organizations, pharmaceutical developers, academics and others) has been working collaboratively since 2016 to address the need for new, innovative … 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
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
Leaping Together Toward Sustainable, Patient‐Centered Innovation: The Value of a Multistakeholder Safe Haven for Accelerating System Change
Clinical Pharmacology & Therapeutics, November 2, 2018Gigi Hirsch Successfully delivering on the promise of emerging science in a world of value-driven healthcare requires that we fundamentally reengineer biomedical innovation processes … Read More
Designing financial solutions to ensure affordable access to cures
The reimbursement of emerging durable/potentially curative cell and gene therapies is likely to be a challenge for the US healthcare market. Considering the pricing of cell- and gene-based therapies approved … 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