Payment Policy

A core portion of ASGCT’s mission is to advance the discovery and clinical application of genetic and cellular therapies to alleviate human disease. A strategic priority of the Society is therefore to advocate to policymakers for maximal patient access to approved gene and cell therapies, which includes support of payment policies that facilitate such access. The unique one-time, potentially curative nature of many gene therapies render them highly valuable, but with associated upfront costs that pose challenges to some payers within the current healthcare system.

The Society supports full coverage, and sufficient reimbursement of providers, for approved therapies, as well as payment models that foster patient access. These positions do not imply endorsement of any individual pricing decisions. More specifically, ASGCT supports the following policies:

• Expedient coverage of gene and cell therapies to their full FDA-labelled indications. State Medicaid programs often do not have coverage policies, and those that do frequently have coverage restrictions.

• Reform of the Medicare Inpatient Prospective Payment System to adequately reimburse providers. Some hospitals have opted not to provide CAR T-cell therapy to Medicare patients because of insufficient reimbursement of their costs.

• Enabling of value-based payment over time, which would tie reimbursement to value and durability, so that payers could stop making payments if a therapy stops working. Legal and regulatory barriers currently exist that can prevent use of these payment models.

Committee Involvement

The Government Relations Committee provides oversight and input to staff on ASGCT’s efforts on payment policy. The Government Relations and Commercialization Committees develop programming at ASGCT’s Annual Meeting and the annual Policy Summit on these topics.

Collaborative Efforts

ASGCT participates in a multi-stakeholder CAR T Working Group, which focuses on payment policy affecting patient access to CAR T-cell therapy.

White Paper

Addressing the Value of Gene Therapy: Enhancing Patient Access to Transformative Treatments identifies priority solutions and areas for further exploration to maximize access to the substantial value of gene therapy.