After decades of setbacks, the promise of gene therapy is rapidly progressing from bench to bedside. The FDA approved the first cell and gene therapies in 2017. Since then, the FDA has approved an additional 15 cell and gene therapies. Cell and gene therapy is a transformative approach that provides new therapeutic options for patients with cancer, immune disorders, hemophilia, eye, and neurodegenerative conditions. However, these therapies present fundamental challenges for payers seeking to balance access, cost, and affordability for members and clients. Often, these therapies are curative, one-time treatments, associated with relatively high upfront costs. This dynamic presents the need for innovation in payment models, benefit design, utilization management and value assessment approaches to ensure access to these therapies in a cost effective and sustainable manner. This session will provide a perspective on the current and anticipated future evolution of this rapidly evolving landscape.
Learning Objectives: :
At the completion of this activity, participants should be able to:
Describe the current and anticipated future landscape for cell and gene therapies.
Discuss considerations and current approaches used to both assess the value of gene therapy and manage costs.
Summarize the range of payment models that payers are both utilizing and considering, including the advantages and disadvantages of each.