How to Manage Costs of Novel Cellular, Gene Therapies: Laura Bobolts, PharmD, BCOP

Monitoring the pipeline of new therapies and ensuring prior authorization with oncology experts are key strategies for managing rising costs, says Laura Bobolts, PharmD, BCOP, senior vice president of clinical strategy and growth at OncoHealth.

This transcript was lightly edited; captions were auto-generated.

Transcript

Can you share which strategies have proven most effective in managing the rising costs associated with novel cellular and gene therapies in oncology?

Novel cellular and gene therapies have been groundbreaking in oncology. They are providing fantastic outcomes for our patients, life-prolonging or life-sustaining outcomes, and they're helping our patients hopefully have more time with their families. But they come at a significant cost. We have to understand how to balance that cost and also provide appropriate accessibility to these novel, groundbreaking therapies.

For me, a strategy that is most helpful is to monitor the pipeline. Make sure you're staying up-to-date with all the latest cellular and gene therapies coming to market so you can prepare your criteria ahead of time, so patients have that prompt access. It's been stated by the American Society of Cellular and Gene Therapy that 715 cellular and gene therapies are in the pipeline for the treatment of cancer. This is coming, this is here, and we have to stay on top of it. You have to monitor the pipeline; that's number 1.

Number 2, make sure you have these agents on prior authorization, but do prior authorization with oncology experts. The reason I say that is I run into some payers who don't have oncology expertise on their end, and they have CMOs [contract manufacturing organizations] reviewing cellular gene therapy. They have multiple different doctors within their payer organization looking at these therapies. Where, if you gave them to those trained in oncology, such as board-certified oncology pharmacists, oncologists on the payer end can understand when these therapies are most appropriate, approve it faster, reducing the admin burden and getting that speed to access for the approval for our patients. So those 2 strategies are most important to me: monitoring the pipeline and having adequate prior authorization with experts in oncology.

How are employer groups collaborating with payers and providers to mitigate the financial burden of these high-cost treatments while maintaining quality care for employees?

I just did a talk with my colleague, Kelly Romo [Kelly Romo, PharmD, BCOP] from Blue Cross Blue Shield of Michigan here at AMCP, and she mentioned to the crowd that employer groups are almost demanding prior authorization on cellular and gene therapy. Why? it's really paramount to have the extra set of eyes on the care to make sure that that patient's absolutely appropriate for that therapy. And then second, I would say that we're seeing employer groups make sure that they have stop-loss coverage in place to cover them for that financial risk, for something that could have potentially been a catastrophic expense with the cellular gene therapy today, with the cost going up to $578,000 for CAR [chimeric antigen receptor] T-cell therapy in the oncology space. We also have a novel cellular and gene therapy for synovial sarcoma that's $727,000 for just 1 dose. Now that's just a drug, right? That doesn't account for the toxicity management and potential hospitalization with that therapy. It's important for employer groups to make sure that that therapy is on prior authorization with the adequate criteria and then, 2, to have stop-loss coverage to protect them for those extraordinary expenses of cellular gene therapy.