Rare Diseases And Orphan Drugs – Access & Reimbursement – Detailed, Expanded Analysis : Gene Therapies For Rare Diseases (US)
With the increasing number of approved innovative, high-cost gene therapies, value assessment and novel approaches to reimbursement are rapidly gaining importance. To assist developers of gene therapies in planning for market access challenges, this study analyzes MCO reimbursement policies and their effect on neurologists’ prescribing of gene therapies that treat the debilitating neuromuscular rare diseases spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD). The report examines commercial plan coverage and restrictions for several marketed therapies—including Novartis’s Zolgensma and Biogen’s Spinraza for SMA, and Sarepta Therapeutics’ Exondys 51 and Vyondys 53 for DMD—and assesses the market access potential for late-phase gene replacement therapies for DMD.
Questions answered
What restrictions do MCOs impose on gene therapies in their largest fully insured commercial plans, and to what extent do they limit neurologists’ prescribing of these therapies?
What kind of contractual arrangements, including rebate contracts and risk-based contracts, do MCOs have with marketers of gene therapies?
What kinds of price concessions and clinical data do payers want to see to favorably cover emerging gene therapies, and what pharmacoeconomic models are they most likely to use in their decision-making?
How likely are neurologists to prescribe emerging gene replacement therapies for DMD? What payer controls would constrain their prescribing of these therapies?
Content highlights
Geography: United States.
Primary research: Survey of 100 U.S. neurologists who manage patients eligible for gene therapies. Survey of 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.
Rare Diseases And Orphan Drugs - Access & Reimbursement - Detailed, Expanded Analysis : Gene Therapies For Rare Diseases (US)
Access & Reimbursement | Gene Therapies for Rare Diseases | US | July 2022
Kanika Ujla
Chris Lewis is a primary research manager at Clarivate. She is responsible for the coordination, content review, and content generation of U.S. Access & Reimbursement reports, including authoring select A&R reports on managed care trends. Before this position, Ms. Lewis was a senior analyst at HealthLeaders-InterStudy. She analyzed the managed care markets in California, New York, and Pennsylvania. She also launched and authored the Pharmacy Benefit Manager profile series. She received her bachelor’s degree from California State University in Sacramento.
