Sustainable Gene Therapy Coverage Approaches

Kimberly C. Chen, DO, MSHLM, and Jessica Nance, MD, MS, discuss clinical evidence requirements, pricing considerations, and innovative financing models to provide sustainable coverage for the growing pipeline of gene therapies.

This is a video synopsis/summary of a Peer Exchange involving Ryan Haumschild, PharmD, MS, MBA; Jessica Nance, MD, MS; Kimberly C. Chen, DO, MSHLM; Emma Ciafaloni, MD, FAAN; and Mary Pak, MD, FACP.

Haumschild moderates a discussion on managed care challenges in gene therapy adoption with Chen, focusing on the implications of a growing pipeline of gene therapies for rare genetic diseases. Chen highlights the urgency of providing access to life-saving therapies for patients with limited treatment options while navigating cost-containment measures. The discussion delves into the importance of robust clinical evidence in informing coverage decisions, stressing the need for established outcome measures and longitudinal data to assess treatment efficacy and quality-of-life improvements. Nance emphasizes the critical role of physicians in advocating for patients and conveying the profound impact of gene therapies on disease progression and patient outcomes. The panelists underscore the complexities of integrating gene therapies into health care systems, urging collaboration among stakeholders to develop sustainable coverage models that balance cost-effectiveness with patient access. Haumschild concludes by acknowledging the transformative potential of gene therapies and the ongoing efforts to overcome barriers to their widespread adoption in clinical practice.

Video synopsis is AI-generated and reviewed by AJMC® editorial staff.

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