Gene Therapy Pricing Demands New Payment Infrastructure, Expert Argues
William Padula argues that high-cost gene therapies, priced around $2 million per treatment, require new financing models beyond traditional insurance structures. The opinion piece contends that the barrier to patient access is not the existence of curative treatments but the lack of payment and delivery infrastructure to support them. While the piece does not specify implementation timelines, it addresses broader healthcare financing challenges relevant to high-cost specialty pharmaceuticals. The argument applies to all payers including Medicaid managed care organizations covering members with conditions treatable by gene therapy.
Medicaid MCOs face immediate budget pressure when covering gene therapies for rare diseases, requiring novel risk-sharing arrangements, outcomes-based contracts, or state supplemental payments to avoid catastrophic claims.
Pharmacy · Managed Care · Finance
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