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Gene Therapy, Costs, and Insurers

New gene and cell therapies are causing problems for insurers, particularly in the US, reports the San Diego Union-Tribune.

While the new treatments appear to be effective, they also come with large price tags. For instance, Novartis' Kymriah, a CAR-T cell therapy for acute lymphoblastic leukemia costs $475,000, while Kite Pharma's Yescarta, also a CAR-T cell therapy, though for treating lymphoma costs $373,000. In addition, Spark Therapeutics' Luxturna, a gene therapy that treats retinal dystrophy, costs $850,000 for both eyes. Further, Kaiser Health News last year reported that the price of gene therapies be even higher when the cost of managing side effects or other factors is included.

This, the Union-Tribune now adds, has led health insurers to wonder how to pay for the treatments. The companies developing the treatments try to focus on their value of it, it says.

"When we try to flip that into, 'it's not the price, it's the value', the argument is, 'that's true, but the price is too high,'" Ron Philip, a senior vice president at Spark, said at the Cell and Gene Meeting on the Mesa, according to the Union-Tribune.

The issue, the paper says, is particularly tricky in the US where individuals may move from insurer to insurer and any long-term savings in treatment cost might not accrue to the original insurer. In single-payer markets, the worry is that covering such expensive therapies might affect insurers' budget ability to care for other patients, it adds.

Previously, companies making the therapies have offered alternative payment schemes and lower costs if the treatment doesn't work as expected.