Latest / CareTalk: Healthcare. Unfiltered. / What is The Worth of Gene Therapy w/ ICER President & CEO, Sarah K. Emond, MPP | HealthBiz Briefs

Transcript

What is The Worth of Gene Therapy w/ ICER President & CEO, Sarah K. Emond, MPP | HealthBiz Briefs · CareTalk: Healthcare. Unfiltered.

• 0:00
  How much is gene therapy worth?
• 0:02
  And is that new drug really better than what's already in the market?
• 0:05
  I'd like to know, and I bet you would like to know too.
• 0:14
  Welcome to Health Biz Briefs.
• 0:16
  I'm David Williams, president of Health Business Group here with Sarah Eman, president and CEO of ICER, a comparative clinical effectiveness organization that tackles the fundamental questions in healthcare value for money.
• 0:29
  Welcome, Sarah.
• 0:30
  Thanks for having me, David.
• 0:32
  Why do we need health equity in health technology assessment?
• 0:37
  For the very reason that if we don't address the ways that our systems of delivering healthcare, analyzing evidence, conducting clinical trials have failed to incorporate the perspectives and the experiences of people historically disadvantaged by our healthcare system, then we're not gonna make any progress.
• 0:59
  when it comes to trying to narrow the gap in the health disparities that we see.
• 1:05
  So even though some might say the methods of health technology assessment are pretty nerdy and maybe they're kind of outside the purview of thinking about things like equity, we're happy that we've put out some research and some white papers talking about how we do have a role to play in ensuring that equity is reflected in the methods that we use to decide.
• 1:28
  what a fair price is for what we're paying for in the healthcare system.
• 1:32
  Are those expensive due gene therapies worth the price?
• 1:36
  Some of the price tags are up in the seven figures.
• 1:39
  Many of them are.
• 1:41
  So when you think about some of these gene therapies, the fact that they're delivering tremendous value in a one -time treatment, even if they're not curative, but are delivering benefits for five years, seven years, 10 years, That commands a very high price when you think about things from a value -based pricing perspective.
• 2:02
  And that's great.
• 2:04
  However, our healthcare system is not really designed to know how to pay for all of that value at once.
• 2:12
  So we have a lot of work to do on the payment side, whether it's outcomes -based contracts, warranties, risk pooling, reinsurance.
• 2:19
  There's a lot of tools out there.
• 2:21
  that we might need to use in combination to ensure access and a healthy innovation signal for the future of these gene therapies.
• 2:29
  But a lot of these gene therapies with those very high price tags represent good value.
• 2:34
  It doesn't mean all of them do, which is a bit of a plug for an independent analysis of the value like we do at ICER to make sure that the companies are producing evidence that there is value to patients.
• 2:48
  And we don't want to get into the, the, the place of just paying a high price because it's a gene therapy without adjudicating whether or not the evidence is there.
• 2:58
  But by and large, the research that we've done on several gene therapies have shown that multimillion dollar price tags are fair.
• 3:05
  How have the drug companies reacted to ICER's work, maybe originally and now more recently?
• 3:12
  That's definitely been an evolution.
• 3:14
  And I think there was a lot of pushback from the industry writ large.
• 3:19
  Not necessarily from individual companies, well, there might've been some of that, but if you're just thinking of it from like a lobbying perspective and what they were worried about, you know, it's their job to protect what now is essentially government granted monopoly pricing, and they don't want any change to that.
• 3:35
  And I understand that from a business perspective.
• 3:38
  But what's been really interesting over the last 10 years that I've noticed is the number of companies that now proactively say, I have picked a price in the ISA range.
• 3:49
  I used, I referenced an independent analysis of comparative clinical effectiveness and cost effectiveness to say, to decide on what I'm gonna charge society.
• 3:59
  And you know what some of those companies then say is, hey, pay your community, you do your part and make sure patients are getting access in a way that's not onerous.
• 4:07
  That means no crazy utilization management, no crazy cost sharing so that we can deescalate this arms race.
• 4:14
  So recently, Madrigal Pharmaceuticals did this in the approval for their new drug for MASH or NASH, which is a type of steatohepatitis, where they said in their investor presentation, we priced it on the upper end of ICER's price range in service to having better access for patients.
• 4:33
  We've done the right thing.
• 4:35
  We've picked this price from an independent analysis.
• 4:38
  And that type of behavior is starting to happen more often, which I think is a signal that there's a lot of people interested again in deescalating this arms race of higher and higher prices and more and more access restrictions and costs for patients.
• 4:54
  Well, that's it for the latest health biz brief.
• 4:56
  If you like what you hear, check out my health biz podcast for a full length interview with Sarah about her life and career.
• 5:03
  Sarah Eman, president and CEO of ICER.
• 5:06
  Thanks for joining me today on health biz briefs.
• 5:09
  Thank you, David.