Highlights August 2021
Paying for Cures: Framing the solutions
Payer perspectives on financing and reimbursing cures
The reimbursement of emerging one-time high-cost durable/potentially curative cell and gene therapies is likely to be a challenge for US payers. The pricing of currently approved treatments and the cumulative cost impact as pipeline agents are approved are likely to challenge payers’ ability to provide affordable health coverage.
We surveyed payers to understand their interest in considering new financing approaches, the potential priority and timing of their actions, and considerations for adoption.
Precision Financing Strategies
Durable therapies create three financial challenges: Payment timing, therapeutic performance risk, and actuarial risk. The NEWDIGS FoCUS consortium has worked to address the need for new, innovative financing and reimbursement models for durable/potentially curative therapies in the US to ensure patient access and sustainability for all stakeholders.
Called Precision Financing Solutions, our innovative and evolving recommendations can help self-insured employers evaluate their risks and explore combinations of solutions to meet the challenges they face.
Paying for Cures Toolkit
The FoCUS Project at MIT NEWDIGS has developed this Toolkit as a resource for practitioners facing the financial challenges of offering, choosing, reimbursing or supporting an advanced durable therapy.
Use the toolkit to assess your situation, survey potential solutions, and start planning for success.
We want to know what works for you, and what doesn't. Please share your thoughts with us!
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Paying for Cures is an initiative of the FoCUS Project at MIT
FoCUS seeks to collaboratively address the need for new, innovative financing and reimbursement models for durable therapies that ensure patient access and sustainability for all stakeholders. This multi-stakeholder effort unites developers, providers, regulators, patient advocacy groups, payers from all segments of the US healthcare system, and academics working in healthcare policy, financing, and reimbursement.
FoCUS research and design
- Engaged cross-sector, multi-stakeholder group to identify challenges and cooperatively design sustainable solutions
- Analyzed drug pipeline to understand scale of the challenge
- Described system of “Cure Archetypes” and how different kinds of healthcare payers can support them
- Designed and served as a catalyst for Precision Financing pilots to test real-world application
MIT Center for Biomedical Innovation
Massachusetts Institute of Technology
77 Massachusetts Avenue
Cambridge, MA 02139