While gene therapy could deliver “substantial benefits,” some patients could be hampered by access barriers, payer strategies and how the two interact with each other, a blog post published on Health Affairs states.
The authors, in an effort to gain some insights on payer concerns and what that means for patient access, conducted online market research to learn the roles both existing and alternative payment strategies could ease the financial burden associated with gene therapies.
In the post, the study’s authors published findings from their research, which included the perspectives of pharmacy directors from 21 managed care organizations.
“Rare diseases that are associated with high health care costs can pose actuarial risk challenges; while the odds of having a treated patient in the plan population in a given year are low, if there were such a patient, the associated plan costs would be very high and could have a material impact on overall per-member-per–month costs,” the authors states. “In the small-group market, the random occurrence of a rare but expensive event or outcome can have a significant impact on plan spending, making financial planning difficult.”