What Dr Jane F. Barlow Sees in the Future for Reimbursement for High-Cost Therapies

The greatest unknown if which reimbursement model for these high-cost therapies will gain supremacy, explained Jane F. Barlow, MD, MPH, MBA, senior advisor, Center for Biomedical Innovation at Massachusetts Institute of Technology.

TranscriptWhat do you see in the future for reimbursement for high-cost therapies?

I think that the greatest unknown in this, and I think there are a lot of unknowns, is which model will gain supremacy. So, if I had to bet, I think there’s definitely going to be a performance-based aspect of it. Whether its shorter or long term, it’s still unclear because of the complexities of managing this over the longer term. I think there’s opportunities for new players like third-party administrators to help with some of the data capture and looking at people’s movement between plans and their outcomes if they leave a plan.

I think providers will have a piece in that, in monitoring patients and getting reimbursed for monitoring patients’ outcomes in ways maybe that they haven’t always had good reimbursement in the past. And then, the greatest unknown is the aggregate effect of all these new therapies as they gain approval. I think there’s dozens of therapies that potentially could be approved between now and 2025. One is the number of therapies and the other piece is the number of patients who are eligible and that total cost that will potentially be on the table. Whether people can bear that in the short term or need to move to new models is still unknown and a lot will play out as the approvals move forward.