Dr Michael Kolodziej Weighs In on Paying for One-Time, Curative Therapies With High Price Tags

Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc, on whether payers will get more comfortable paying for one-time, curative therapies with high price tags.

Transcript

With more value-based agreements being introduced, do you think payers will become more comfortable with paying for one-time, curative treatments with high price tags?

Oh that’s much harder. I think the question of how we’re going to pay for, let’s start with [chimeric antigen receptor T] or gene therapy or whatever else the next thing is. I think we are not even close to a solution for that. In fact, we know, for example, that Medicare has completely fumbled the ball. They have not done very well with how they pay for CAR T. Now, mind you, CAR T is mostly inpatient right now. But the. [diagnosis-related group's] messed up, the outlier payments require that providing facility to literally lie about how much they spend on the drug. So, it’s all messed up

Commercial payers right now, because they’re relatively rare events, are just doing what commercial payers do. They negotiate on the individual patient level and as we’ve seen literally in the last 2 weeks, Cigna and CVS/Aetna has come out with let’s just call them old-school models for dealing with risk. Nothing very exciting. So, I’m hoping that as we get more therapies in this space, we’ll see some evolution in the thinking to a more innovative approach. For example, I love the idea of an outcomes-based contract. We haven’t really seen very many outcomes-based contracts in this space. I love that idea very much. I think the idea that we’re going to pay for value, the value that they bring, should resonate with all payers.

Now, there’s a very important proviso, and that is that these are in fact curative therapies, and if anybody thinks they know they are curative therapies, they’re nuts. The follow-up just has not been long enough and there haven’t been enough patients treated. So let’s hope that the science does in fact bare out and we do enjoy the kind of benefits that these therapies might provide us.