Trends, Entrants, and Developments (TEDs) Impacting Access: Cancer Care and Gene Therapies—Innovative Payment Models Cover High-Cost Therapies and the Growing Influence of Specialty Pharmacies

Good day to you; I am Elizabeth Oyekan, PharmD, FCSHP, CPHQ, Vice President—Access Experience Team, editor of the All Access newsletter. As we come to a stabilizing stage in the COVID-19 pandemic, the US is refocusing its attention back to the pursuit for value-based care and is revisiting the cost and value of drug therapies.

Therefore, in this edition of the All Access newsletter, we have asked our key expert ex-payers to provide insights into the trends and developments impacting access in cancer care, rare diseases, and gene therapies including innovative payment models, value-based care delivery models, and the growing influence of specialty pharmacies in the quest to optimize access to these high-cost therapies.

  • Ray Roth, MD, Senior Advisor: focuses on the innovative research in cell and gene therapy looming on the horizon of medicine and the implications for disease treatment. He reviews the implications of the current “exponential growth phase” of gene therapy including the benefits and risks of these therapies, the financing and partnerships occurring, and payer issues and tactics for supporting the reimbursement for cell and gene therapies.
  • Kellie Rademacher PharmD, VP Access Experience Team: addresses the exponential growth of rare and orphan drug therapies in the last decade, their costs and impact to payers and the overarching healthcare systems. She discusses the challenges and opportunities around the value-based agreements that are being explored to pay for these therapies including measures and other factors that will make these value-based contracts worthwhile, while maintaining healthcare affordability.
  • Erin Lopata, PharmD, VP Access Experience Team: focuses on the specialty pharmacy’s (SPs) role in gene and cell therapies for all stakeholders including payers, providers, manufacturers, and patients. She highlights the SP’s roles in partnership coordination between payers and manufacturers, the leveraging of data to support arrangements, and the focus on patient-care coordination and financial support to improve patient outcomes.
  • Janet Serluco, MS, VP Access Experience Team and Oncology Lead: addresses trends impacting access in cancer care and the innovative payment models being considered to pay for these high-cost therapies. She discusses the role of value-based care delivery models in oncology built on collaboration, communication, and shared goals, as they focus on demonstrating value by improving quality and access while lowering costs. She also reviews the results of a proprietary Precision Value and Health survey designed to capture payer and provider challenges around the delivery of value-based care in oncology. Finally, she further explores innovative payment models and the need to focus on value of therapies in the oncology and gene therapy space to support access and reimbursement.

We believe you will find these trends impacting access to cancer care and gene therapies and the growing influence of specialty pharmacies insightful as you continue to navigate the payer landscape. As always, please feel free to drop me a note, and let me know if you have a topic suggestion for the payer team to address, and we’ll do our best to cover it in a future edition.

Best regards,

Elizabeth Oyekan
PharmD, FCSHP, CPHQ
Vice President,
Access
Experience Team

EMAIL ELIZABETH

All Access is a bimonthly newsletter that features key insights from our team of former payers, intended specifically for market access leaders. It is published by PRECISIONvalue.

Guest Editor
Elizabeth Oyekan

Executive Editor
Louis Landon

Contributors
Andrew Cournoyer
Ryan Cox
Dan Danielson
Todd Edgar
Dominic Galante
Ami Gopalan
Maureen Hennessey
Joe Honcz
Louis Landon
Erin Lopata
Reta Mourad
Kellie Rademacher
Charline Shan

Cell and Gene Therapy Circa 2021

Stay up to date on the innovative research in cell and gene therapy and the implications for disease treatment. Ray Roth reviews the benefits and risks of these therapies, the financing and partnerships occurring, and payer issues and tactics for supporting the reimbursement for cell and gene therapies.

Specialty pharmacy’s role in gene and cell therapies

What role do specialty pharmacies have in cell and gene therapies for payers, providers, manufacturers, and patients? Erin Lopata highlights the SP’s roles in partnership coordination between payers and manufacturers, the leveraging of data to support arrangements, and the focus on patient-care coordination and financial support to improve patient outcomes.