How Can Payers Support the Success of Value-Based Contracting Deals for Innovative Therapies?

The world of cell and gene therapy is rapidly advancing, with 2,053 therapies in development from pre-clinical to post-market stages. Projections indicate that by 2026, spending on these therapies could reach $30 billion. While these innovative treatments offer hope for rare and chronic diseases, managing their costs poses a significant challenge.

At the recent Abarca Forward conference in Puerto Rico, experts gathered to discuss novel financial strategies to address these challenges while ensuring sustainability for payers.

The panel emphasized the importance of value-based pricing arrangements to align incentives among payers, pharmaceutical companies, providers, and patients. They also highlighted key considerations for successful value-based contracting deals.

Anne Winter, from FTI Consulting, led the discussion on innovative financing approaches to make high-cost drugs more accessible. Various organizations are exploring alternative financing and coverage policies to support patient access to these life-changing therapies.

New financing models, such as recommendations from MACPAC and initiatives like the NEWDIGS Think Tank at Tufts University, are gaining traction in the industry.

These efforts aim to develop sustainable reimbursement models that benefit patients, payers, and manufacturers alike.Girisha Fernando, CEO of Lyfegen, highlighted the importance of stakeholder engagement in successful value-based contracts. Criteria such as real-world efficacy, budget impact, and outcome measurement are crucial for evaluating the value of these therapies.

Data integrity and verification play a vital role in assessing therapy effectiveness, as noted by Rafa Chaves from Organon. Companies must have a comprehensive view of patient outcomes to demonstrate the value of these advanced treatments.

In the evolving landscape of cell and gene therapy reimbursement, collaboration among stakeholders is essential to navigate challenges such as pricing, coverage determination, and outcome evaluation.While uncertainties persist, there is optimism around the potential long-term benefits of these therapies, including reduced hospitalizations and lower medication costs for cured patients.