Posted by Michael Wonder on 13 Apr 2019
How are gene therapies going to get paid for?
12 April 2019 - Ideally, gene therapies address the root causes of disease with a single curative dose.
If they can replace a lifetime of expensive maintenance treatments this may lead to cost savings in the long run. Yet, the high upfront costs and uncertainty surrounding long-term efficacy and adverse events have caused payer push-back. Payer concerns are further exacerbated due to there being hundreds of gene therapies in the pipeline, across a wide range of therapeutic categories, from sickle cell anaemia to HIV. Should many of these gene therapies be approved in the coming decade the budgetary impact burden on payers could become overwhelming.
Furthermore, the churn at U.S. insurers, as beneficiaries frequently switch plans, lowers the potential return on investment for payers. Being saddled with high upfront costs without necessarily experiencing the downstream long-term benefits and cost offsets of gene therapies is a problem for which a structural solution has not yet been found. Pricing and in particular financing remain fiercely debated issues.
