Share the researchWhile the problem of finding system-wide, implementable precision financing models for curative and durable therapies involves all stakeholders, patients and caregivers are directly affected by many different elements … Read More
Warranty Model: A potential precision financing solution for durable cell and gene therapies
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
Impact of FDA Guidelines on Communication between Developers and Payers on Metrics in Performance-Based Agreements
The FDA regulates communications from pharmaceutical developers to ensure that statements about products are appropriately supported by evidence. In this Research Brief, we explore the possible impacts of these regulations … 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
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
Payer Perspectives Survey
A survey of 77 payers representing over 280 million lives, completed in April 2019, explored perspectives concerning financing challenges and management strategies associated with durable cell and gene therapies. Download … Read More
Estimating the Clinical Pipeline of Cell and Gene Therapies and Their Potential Economic Impact on the US Healthcare System
Value in Health, June 2019Casey Quinn, Colin Young, Jonathan Thomas, and Mark Trusheim Cell and gene therapies promise durable clinical benefit from a single treatment course. High upfront reimbursement for … Read More