(W6) Gene Therapies: Forecasting Potential Candidates Using Integrated Medical and Pharmacy Claims Data

With five FDA-approved one-time treatment gene therapies ranging in price from $850,000 to $3.5 million and expected FDA approvals of more than five per year for the foreseeable future, it is essential managed care pharmacists have fundamental gene therapy candidate forecasting knowledge with regard to identifying gene therapy candidates and the financial risk associated with gene therapy. This information can be shared within finance and actuary teams to make business decisions such as purchasing stop loss insurance or reinsurance coverage, making premium adjustments or changes, and approaching gene therapy manufacturers for value-based purchase agreements.

This session will demonstrate how to operationalize the gene therapy clinical trial inclusion and exclusion criteria to health insurer available data including age, gender, medical claims containing diagnoses, procedures, and resource use, along with pharmacy claims data to identify gene therapy candidates and the financial risk associated with gene therapy.