Following the news that Swiss pharma major Novartis is finding it difficult to win payer coverage for its new $2.1m gene therapy to treat spinal muscular atrophy (SMA)–Zolgensma,
Vinie Varkey, Senior Analyst of Neurology & Ophthalmology at GlobalData, a leading data and analytics company, offers her view:
“The situation is not perceived as one that is insurmountable. It largely represents a set of teething problems facing two main players in the healthcare industry in the event of an innovative therapy launching in the market: the healthcare funding stakeholders and the pharmaceutical companies developing these therapies. Zolgensma’s price point of $2.1m in the US for a one time treatment makes it the most expensive treatment ever.
“Zolgensma’s high price point was expected to unsettle the funding agencies and any relevant decision made by insurance companies with regards to Zolgensma is one that is expected to be characterized by push-backs. For instance, some payers may decide to restrict Zolgensma to the most severely affected patients rather than to all patients for whom the treatment is indicated and approved for. Restricted access is seen as the caveat for a therapy with an exceptionally high price point. The challenge also represents an opportunity for pharmaceutical companies to lead productive discussions with reimbursement agencies and help develop sustainable funding mechanisms that can eventually help their therapies to launch in the market and ensure access to a wider patient population.
“According to GlobalData’s recent report, ‘Spinal Muscular Atrophy (SMA): Opportunity Analysis and Forecasts to 2028’, the SMA market is expected to grow at a compound annual growth rate of 16% to reach a global value of US$6.6bn in 2028. Zolgensma is expected to be the market leader in 2028 with peak year global sales of US$3.1bn.
“Zolgensma’s challenge of finding favor with majority of the insurance companies in the US, provides a snap shot of the reimbursement challenges that are likely to face transformative gene therapies which are expected to launch at a higher price point compared to traditional treatment approaches. As a one-off therapy, this treatment regimen has a disease curative potential and is therefore likely to help save downstream healthcare associated costs in the long-term compared with a patient who has to undergo chronic treatment regimen to help deal with the disease.”