Cell/Gene Therapy Pay Models Face Reporting, Policy Barriers

Emerging cell and gene therapy oncology treatments are well suited to value-based payment arrangements, but new contracting models must be able to contend with a complex regulatory and financial environment, experts say.

A new generation of oncology treatments that can cure specific cancers offer a potential breakthrough. Patients who would have had to struggle through chemotherapy and still faced long odds now have the chance to make a significant recovery with one or two rounds of treatment. However, these treatments are extraordinarily expensive — some can cost tens of thousands of dollars for a single course of treatment.

“Because they’re typically only administered once, that single administration has a high associated cost that’s not spread out over time,” explained Jay Jackson, a principal at Avalere Health, during a June 29 podcast.

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Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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