Durable cell and gene therapies are poised for rapid growth – potentially providing transformative benefits for patients and exacerbating financial challenges for payers, providers, patients, and therapeutic developers. With five … Read More
Payer Perspectives on Reimbursement of One-Time High-Cost Durable Therapies
Pharmaceutical Executive, January 9, 2020Matt W. Courtney, Jane F. Barlow, Mark Trusheim The reimbursement of emerging durable and potentially curative cell and gene therapies challenge U.S. payers due to their … Read More
Precision Financing challenges for solid tumor adoptive T-cell therapies
Durable gene and cell therapies represent a unique challenge to the US healthcare insurer/payer landscape, given the one-time treatment and associated high upfront cost but potentially durable outcomes. Previous research … Read More
Tools for Implementation of Precision Financing Solutions Within Medicaid Plans
Implementation of precision financing solutions is a challenge for state Medicaid payers given the complexity of the environment. This white paper provides example templates to support state Medicaid plans, manufacturers, and … Read More
Tracking Medicaid Coverage of Durable Cell and Gene Therapies
Durable cell and gene therapies represent a unique challenge to the US healthcare insurer/payer landscape, given the one-time treatment and associated high upfront cost but potentially durable outcomes. This study … Read More
The Role of Stop-Loss Insurance and Reinsurance in Managing Performance-Based Agreements
Over the last decade, rising healthcare costs and the availability of expensive new treatment options has led to a substantial increase in the number of patients with large insurance claims. … Read More
State Insurance Regulations Regarding Benefit Design (Deductible and Co-Pay Waivers)
FoCUS has identified an issue that may be a barrier to timely patient access to durable therapies. The advent of expensive, one-time durable therapies will require changes in private payer … Read More
Are Payers Ready, Willing, and Able to Provide Access to New Durable Gene Therapies?
Value in Health, June 2019Jane 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. … Read More
Massachusetts Pilot Disease Selection
Rheumatoid Arthritis (RA) chosen as target for LEAPS Massachusetts (MA) Pilot (RAMA) to demonstrate the feasibility and impact of a sustainable and patient-centered healthcare learning ecosystem to optimize care regimens … Read More
Pediatric Gene Therapy Launches
Gene therapy cures for hereditary genetic conditions are likely to reach the United States market in the coming decades. Several disease areas with potential cures are orphan conditions, which affect … Read More