James Chambers

In the most recent SPEC Database update, we added six 6 drugs and 18 new indications for existing drugs

The SPEC Database tracks health plans’ drug coverage criteria and the evidence base that plans report reviewing when formulating their policies

How will US commercial insurers cover the recently approved sickle cell disease gene therapies?

In our blog, we make some predictions, based in part on how plans cover existing SCD therapies.

t.ly/u4q9O

@SickleCellMI @mollytoba @PeterNeumann11

Yesterday, #ICER published its report on Unsupported Price Increases of prescription drugs

ICER judged that 8 of the 10 assessed drugs lacked adequate evidence of added clinical benefit

The SPEC Database includes 7 of those drugs

Here we show how plans cover those treatments

FDA is expected to soon approve 2 gene therapies for sickle cell disease (SCD)

How do payers cover existing SCD treatments?

The SPEC Database includes 3 SCD therapies: Adakveo, Endari, & Oxbryta

Analysis shows that plans impose restrictions on these therapies 98% of the time

Last week, we made 3 predictions for specialty therapy coverage in 2024
1. Coverage becomes more restrictive
2. More utilization management for cell & gene therapies
3. Plans increasingly prioritize biosimilars

Here is a link to the recorded webinar

tinyurl.com/3d8kc9j5