Reimbursement for Gene Therapy breaks new ground – Spark Therapeutics announces an Innovative Pricing Plan for Luxturna

Wed, 2018 / 02 / 07

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Ihr Ansprechpartner Prof. Matthias P. Schönermark, M.D., Ph.D.
Prof. Matthias P. Schönermark, M.D., Ph.D.
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With highly expensive gene therapies entering the market, payer organizations face serious challenges affording those therapies for their patients. While for this type of medicine a single administration is often sufficient for cure, prices for this administration are still tremendously high, for example reaching up to over a million dollar for Glybera. Traditional payment models are based on the amount of administered medicine, where treatment duration and dosage serve as a correlative measure for the effect of the treatment.

This approach is now turned upside down with single-use medicines such as gene therapies. To make gene therapies affordable, pharmaceutical companies and payers now have to create entirely new payment models. Sparks Therapeutics has announced a pricing plan for its new gene therapy Luxturna (voretigene neparvovec), with a total price of USD 850,000 and a pricing plan which includes three special steps:

  1. A rebate program is offered to payers, based on Luxturna’s effectiveness which is assessed at 30 to 90 days, and again at 30 months. Rebates are planned to be limited to the standard Medicaid rebate.

  2. Spark plans to form contracts directly with payers or their specialty pharmacies, who will then negotiate prices with treatment centers. With this model, treatment centers shall be protected from treating patients without being reimbursed by the patient’s payers.

  3. Payers shall be enabled to reimburse Luxturna in installments spread over a duration of several years. To this end, Spark is in discussions with CMS.


Open discussion of these payment innovations has helped Spark to avoid a reputation as a profiteering company and highlighted Spark’s innovative efforts that gain interest from other larger pharmaceutical companies with gene therapeutic products. Novartis, as another example, has likewise started to create adaptive payment models for their CAR-T drug Kymriah.

Novel pricing models such as pay-per-performance might in the future also influence reimbursement of other expensive therapies. Those and other potential reimbursement models for highly innovative therapies, especially gene therapies, were discussed in-depth in a contemporary article in the magazine ‘Welt der Krankenversicherung’ (10/17) written by Prof. Matthias Schönermark and Ms. Thora Mrosowsky from SKC consulting.

Please click here to read the article in English.

Please click here to read the article in German.

BY Prof. Matthias P. Schönermark, M.D., Ph.D., Founder and Managing Director of SKC Beratungsgesellschaft mbH and Dr. Angelika Hinz, SKC Beratungsgesellschaft mbH

Sources:
Fierce Pharma: Payers point to Spark’s gene therapy as a model for innovative pricing plans
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