ISSUE: The cost of gene therapies is unlike anything the healthcare industry has witnessed before. In 2019, Novartis’ spinal muscular atrophy gene therapy, Zolgensma, was priced at a record $2.125 million, with the Institute for Clinical and Economic Review commenting that this price is justified by the value provided. The industry has now set a precedent, demonstrating that governments and health insurers are willing to pay premium prices. With several curative therapies launching on an annual basis, it is important to consider how payers are responding to the funding and access challenges posed by these therapies, and what are the remaining enduring challenges that must be tackled? These include access inequities between private and public healthcare plans, implementation of value-based contracting, and issues with portability between private healthcare plans.

OVERVIEW: Kate Hanman will moderate and introduce the key challenges currently facing payers providing coverage for gene therapies. Debra Miller (patient panelist) will outline the patient perspective of access to curative therapies and explore the inequities between private and public insurance plans. Ramesh Arjunji (industry panelist) will debate what types of arrangements manufacturers should anticipate making with government healthcare providers to ensure gene therapies are not excluded from coverage. Michael Sherman (payer panelist) will discuss how drug manufacturers can best work with insurance providers to manage the financial risks associated with increasing numbers of marketed gene therapies, including addressing issues around portability when patients switch healthcare insurers.