Dr Jane F. Barlow on How Curative, High-Cost Therapies Will Affect Patient OOP Costs

Jane F. Barlow, MD, MPH, MBA, senior advisor, Center for Biomedical Innovation at Massachusetts Institute of Technology, discusses how curative, high-cost therapies will impact patient out-of-pocket costs and cost sharing.


How have curative, high-cost therapies impacted patient out-of-pocket costs and cost sharing?

Well, for most of these conditions, patients already have very high out-of-pocket costs. We’ve moved, in this country, to a lot of high-deductible plans and have high maximum out of pockets. So, most of these patients, I believe, will already meet their out-of-pocket maximum. So, whether they have an expensive treatment over time or they have one very high-cost treatment, I’m not sure it’s going to make a difference for the member in that year of treatment.

I think the real question is how does this sort of net out for them over time, is one piece, and whether their costs will be less in future years than it would have been if they were having other treatment or they had chronic costs. Or you know, the other question is, just the affordability in general. So, if patients choose not to get this new therapy because they just look at the overall cost and say it’s too much and they forgo therapy all together, that won’t be a good thing either. So, I think it’s a piece that has to be addressed, but it’s a broader issue than just the gene therapies.
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