Private Insurers Use Creative Payment Models for Pricey Therapies

Medicare’s recent decision to guarantee government coverage of breakthrough cancer treatments is spurring a different reaction from private insurers: They are likely to rely on creative payment models to finance the costly therapies.

The Centers for Medicare & Medicaid Services will offer uniform national coverage for Yescarta by Gilead Sciences Inc. and Kymriah by Novartis AG beginning Oct. 1, 2020. The two therapies are the only FDA-approved “CAR T-cell” therapies to treat lymphoma and leukemia. The treatment uses a patient’s genetically modified immune cells to fight the illness. The government now covers the treatment on a case-by-case basis.

Despite advances ...