Value-based contracting in the US is moving toward high-cost drugs for rare disease and away from lower cost chronic treatments as payers plan for the coming pipeline of cell and gene therapies. Marketed gene therapies all have some kind of risk sharing deal in place but further progress on the most innovative payment models is hampered by regulatory and operational challenges. The Centers for Medicare and Medicaid Services has taken a first step toward addressing regulatory obstacles but there is a long way to go.

Risdiplam’s efficacy across two clinical trials and oral dosing made it a credible threat before its US FDA approval, but its weight-based pricing falls below Biogen’s Spinraza and Novartis’s Zolgensma. 

Payer concessions to ensure access to drugs during the COVID-19 outbreak offer a benefit to patients and biopharma. But the costs involved could intensify future efforts to manage drug spending.

But declines in other categories held overall spending on US retail pharmacy drugs covered by commercial plans to a marginal 2.3% increase in 2019, Express Scripts reports.