We have arrived at a special moment in health care. Innovative, life-changing gene therapies are here that will cure or ease debilitating diseases. Yet these expensive treatments are entering a market structure that was not built to price them.
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I describe five payment approaches that have been proposed. There are certainly others.
1. As Mark R. Trusheim, Peter B. Bach, and I described in an article in the Journal of the American Medical Association, the subscription or Netflix model establishes a single set of predetermined payments and as many affected patients are treated as possible.
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4. Medicaid or some other government program could pay for gene therapies and commercial payers would not have to cover them. Instead, it would be fully backstopped by public funds. Society as a whole pays, as opposed to just the insurance pool to which the patient belongs at the time the therapy is given.
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Life-changing gene therapies are coming. We must give thought now on how to determine the price of these innovative, new-age treatments and how to finance them to ensure that we realize their full, beneficial potential while also ensuring that society can pay for them.
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