Gene Therapy Could Catalyze More Value-Based Reimbursement

The boom in cutting-edge treatments known as regenerative medicine could spur health insurers to incorporate more real-world evidence to support value-based decisions on coverage.

Regenerative medicine, which includes gene therapy and stem cell treatments, has already made a splash in the market, as exemplified by the availability of Spark Therapeutics’ Luxturna to treat a rare form of blindness. While the $850,000 price tag for this one-time gene therapy product sent waves of sticker shock, Philadelphia-based Spark said it was offering payment programs based on outcomes.

As more regenerative medicine therapies come onto the market, the one-time administration of these ...