Car-T Affordability and Access Alert Issued by ICER in Recent Report

Posted April 5th, 2018 by Be The Match and filed in Payer Policy
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The Institute for Clinical and Economic Review (ICER) recently released a summary report analyzing the clinical and cost-effective benefit of two emerging CAR-T therapies approved by the FDA in 2017:  tisagenlecleucel (Novartis) and axicabtagene ciloleucel (Kite/Gilead).

The report concluded that there was a “net health benefit compared to standard chemoimmunotherapy” as well as stating that both therapies are determined to be “cost-effective in the long term for the specified indications,” (adults with Non-Hodgkin’s Lymphoma and pediatric patients with B-ALL).  However, ICER issued an “affordability and access alert” as part of the final report since findings showed that “the added health care costs may be difficult for the system to absorb over the short term” and that “only 38% of the eligible population of 5,900 could be treated before crossing the affordability threshold.”

The report concludes with key policy recommendations to address affordability and access.  Below is a sample of those policies that should be implemented by payers:

  • Manufacturers, public and private insurers, and providers should meet prior to FDA approval to address uncertainty regarding payment arrangements, a step that will reduce unnecessary delays in delivering care to patients and financial uncertainties for insurers and providers.
  • Value-based pricing should be viewed in context with the affordability of a new treatment based on the size of the population eligible to receive the therapy.
  • Manufacturers and insurers should ensure that outcomes-based pricing arrangements are linked to meaningful clinical outcomes assessed with sufficient follow up.

For additional information, please see the full report.

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