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
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
Precision Financing of Durable, Potentially Curative Therapies
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
Alternative State-Level Financing for Hepatitis C Treatment—The “Netflix Model”
JAMA, October 29, 2018Mark R. Trusheim, William M. Cassidy, and Peter B. Bach Drug prices in the United States remain the highest in the world.1 New payment approaches are needed, … Read More