Managed Healthcare Executive: Insurers must be ready for groundbreaking but expensive new gene therapies, UMass Medical School Pharmacy expert warns

October 24, 2017

A UMass Medical School pharmacy expert is warning managed care plans to keep close tabs on an array of innovative – but also very expensive – gene therapies, according to Managed Healthcare Executive and Specialty Pharmacy Continuum.

Nicole Trask, PharmD, a clinical consultant pharmacist at UMass Medical School, presented at Academy of Managed Care Pharmacy’s AMCP Nexus 2017 about specialty drugs that will be released over the next two years and have substantial budget and clinical implications. Trask’s presentation was featured in an overview published in Managed Healthcare Executive and a video produced by Specialty Pharmacy Continuum.

“Proactive pipeline monitoring and a solid understanding of plan membership are key to anticipating the budget impact of new drugs,” Trask said, according to Managed Healthcare Executive.

In order to be the most successful, Trask said payers need to anticipate which specialty drugs the U.S. Food and Drug Administration (FDA) will approve well into the future. They should also review medical claims to shed light on how many members may be prescribed the new drugs.

“If we’re not looking at least one year in advance we’re kind of behind the eight-ball. So we want to look ahead of time so we can really respond to the market and not really react to it,” Trask told Specialty Pharmacy Continuum.

Therapies expected to receive FDA approval include CAR-T therapy to treat non-Hodgkin lymphoma (NHL) and monoclonal antibodies to treat multi-drug resistant HIV-1.

“I think some of the biggest game changers that we’re going to see are the gene therapy agents as well as the CAR-T therapies. So these are new agents that are completely changing the way that we treat different disease states such as genetic blindness and very hard to treat forms of cancer,” Trask told Specialty Pharmacy Continuum. “These agents, because they are so innovative and they have such small potential treatment populations, they have an astounding price tag."

In the case of NHL, Trask said a CAR-T therapy just approved by the FDA called axicabtagene ciloleucel could have a budget impact of $4.75 million annually for a plan with 100,000 members, Managed Healthcare Executive reports.

Trask said Ibalizumab, expected to be approved by the FDA in early 2018 for HIV-1, could increase the budget of a plan with 100,000 members by a half million dollars a year, according to Managed Healthcare Executive.

“Approval of high-cost gene therapies might highlight the need for innovative payment models,” Trask said, according to Managed Healthcare Executive.

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