Joe Nolan, general manager of U.S. operations at AveXis in Bannockburn, Illinois, describes gene therapy as “really transformative.” That`s on par with medical breakthroughs like cancer immunotherapies, he says. “Zolgensma is a historic breakthrough in the treatment of SMA and a revolutionary unique gene therapy. Our goal is to ensure broad patient access to this transformative drug and share the value with the healthcare system,” said Vas Narasimhan. “We used value-based pricing frameworks to assess Zolgensma at about 50% below several established benchmarks, including the current 10-year cost of treating chronic SMA. To cover the new therapy, Novartis offers payers outcome-based agreements that only spread the total cost over five years if the drug continues to work. Payers welcomed the new models. As of July 2019, about 40 percent of commercial life and four Medicaid plans had policies. Coverage rates quickly increased to 90 percent of commercial lives and 30 percent of Medicaid patients in October, according to CEO Vas Narasimhan. In addition, almost all patients on the label received final approvals after Novartis followed certain appeal procedures, he said. Apart from all the noise, Zolgensma is an effective drug at its core. Significant improvements in motor functions have been demonstrated, such as .
B the ability to sit without support, as well as event-free survival in patients with presymptomatic and infantile SMA, even beyond five years after treatment. Compared to its competitor, Biogens Spinraza – which requires chronic dosing – Zolgensma has the potential to cure the disease with a single injection of an adeno-associated viral vector therapy that carries a functional copy of the human SMN gene. “Innovative science like Zolgensma has forced us to be just as innovative in terms of tailored access solutions to meet the many needs of payers and patients,” said Dave Lennon, President of AveXis. “We are working together to accelerate hedging decisions with government and commercial payers. We offer a pay-for-time model for this unique treatment to accommodate the current structure of the U.S. healthcare system, and we have also entered into outcome-based agreements with payers because we believe in the long-term value of Zolgensma and are ready to support therapy. Nolan: We used value-based pricing frameworks to estimate Zolgensma at about 50% below several established benchmarks, including the current 10-year cost of treating chronic SMA. The current 10-year cost of chronic treatment given over the patient`s lifetime can often exceed $4 million in the first ten years of a young child`s life. In addition, this therapy stops working when the treatment is stopped. Many insurers currently cover the costs of treating chronic SA and would therefore realize cost savings with Zolgensma over time. Government payments, reviews and reimbursements if the drug is not effective would extend over five years.
Novartis regularly offers a five-year payment schedule for Zolgensma. The company said in a statement that these so-called value-based or earnings-based agreements are also becoming routine. He is said to be in “active talks” with Massachusetts. These payers include Harvard Pilgrim Health Care, which has made a name for itself with revolutionary results-oriented companies with the industry. .