Asembia ASX26: How Payers are Embracing Value-Based Care Models for Cell & Gene Therapies

While advances in cell & gene therapy continue to show promise for creating new treatments, this sector of the industry still faces a major hurdle: the high costs. Whether it’s on the R&D side or delivering and administering the treatment to the patients, cell& gene therapies are expensive.

Pharmaceutical Executive spoke with Aradigm Health CEO Will Shrank at the Asembia ASX26 Summit in Las Vegas. During the conversation, he explained the issues the payers face with cell & gene therapies, along with the strategies that the industry is using to move forward with these treatments.

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Pharmaceutical Executive: Are payers embracing value-based care models for cell & gene therapies?
Will Shrank: They are. This is a category that's somewhat different than our history with value-based contracting for drugs. I say this with a lot of humility. When I worked at Humana, when I worked at UPMC, we had a lot of value-based contracts with manufacturers. I think they, frankly, were a little bit more window dressing than they were true alignment of financial interest between the manufacturer and the purchaser.

Where we've fallen down in the past is it's been hard to get aligned around measurement. It's been really hard to determine what the counterfactual would be for these therapies that often can cost millions of dollars and purport to be a cure, where the outcome is binary, either it's cured or not.

It's a lot easier to get aligned around those outcomes. So, if somebody receives a therapy for hemophilia and they are readmitted to the hospital with a bleed, we know it didn't work. If someone's treated for sickle cell disease and they get readmitted to the hospital for a vaso occlusive crisis, we know it didn't work.

The magnitude of the cost also creates this urgency around alignment. This is the moment for us to really jump in in a much more meaningful way to create alignment around those contracts between the purchaser and the manufacturer, around outcomes and value.