Payers are concerned about gene-therapy drug costs: 5 things to know

The survey, published May 1, asked 182 benefits leaders at employers and health plans about their organization’s specialty drug benefit design. 

Here are five findings to note: 

1. Half of payers surveyed said gene therapy affordability will be a major challenge in the next two to three years. Around 1 in 4 employers surveyed anticipated a major challenge from the pricey new drugs.
2. Few organizations are participating in value-based contracting for specialty drugs. Around 1 in 4 payers said they are using value-based contracts for specialty drugs, compared to just 5 percent of employers. 
3. Few organizations surveyed used alternative payment models, like grants and manufacturer patient programs, to pay for specialty drugs. Fourteen percent of employers surveyed said they use alternative payment models, compared to 7 percent of payers. 
4. Half of payers surveyed said they use site of care programs to reduce specialty drug costs, compared to 25 percent of employers. 
5. Health plans surveyed rated cost parity across medical and pharmacy benefits as the top challenge concerning specialty drug costs. Employers rated affordability for members as the top concern. 

Read the full report here. 

At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.