Gene & Cell Therapy Management Service
Problem
With an estimated 60+ gene & cell therapies to be approved in the next eight years, the cost to the healthcare system could be as high as $100 billion. These new therapies will challenge existing business models and drive uptake of outcomes-based agreements.
Gene therapies are projected to be very expensive
- A single therapy could be as high as $4 million per patient
- Some patients will be treatment-resistant putting millions of dollars at risk
Administering outcomes-based agreements will be costly and time-consuming
- It is extremely difficult to capture high-quality patient-reported outcomes data
- It is time-consuming to capture clinical data from physicians, pharmacies and laboratories
- The burden is on the payers to prove when a particular therapy fails
With each new therapy approved, payers will have another unique set of outcomes to capture and contract requirements to meet. This complexity will cause the administrative burden to continue to climb.
Solution
Audaire Health’s new Gene & Cell Therapy Management Service is the first of its kind, leveraging our provider friendly web-application to capture all necessary data to efficiently adjudicate outcomes-based agreements - ensuring our payer partners get the maximum value from these novel durable therapies.
This white-glove service will:
- Capture patient-reported outcomes data and critical clinical data
- Aggregate all data into product-specific reports
- Administer the contract on behalf of the plan
Hemophilia A Gene Therapy example:
- $3 million x 5 patients = $15m total cost
- Efficacy:
- Three members = full response
- One member is 50% responder = $1.5 million in lost value
- One member is a treatment failure = $3 million in lost value
- Financial Risk = $4.5 million in wasted budget spend