Perspective from Julia A. Haller, MD
January 03, 2018
2 min read
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Price for Spark's gene therapy for blindness set at $850,000

Perspective from Julia A. Haller, MD
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The wholesale acquisition cost of one-time Luxturna treatment for confirmed biallelic RPE65 mutation-associated retinal dystrophy is $425,000 per eye, Spark Therapeutics confirmed in an email to Healio.com/OSN.

Spark Therapeutics also announced three new payer programs: an outcomes-based rebate arrangement with long-term durability measure, a contracting model and a proposal to CMS under which payments for Luxturna (voretigene neparvovec-rzyl) would be made over time, according to a company release.

Luxturna will cost $850,000 total to treat both eyes. Biallelic RPE65 mutation-associated retinal dystrophy affects 1,000 to 2,000 patients in the U.S., according to the FDA.

In its outcomes-based rebate arrangement, Spark Therapeutics reported it will share risk with certain health insurers and pay rebates if patient outcomes fail to meet specified thresholds.

For its contract model, Spark Therapeutics would enter into an agreement with commercial payers under which the payer or payer’s specialty pharmacy purchases Luxturna. The payer agrees to provide coverage for its members consistent with FDA labeling of Luxturna, expedite benefits processing and cap patient out-of-pocket amounts at in-network limits. Additionally, the payer would agree with the treatment center on reimbursement, according to a company release.

Finally, Spark Therapeutics is seeking to allow customers to pay for Luxturna in installments. However, under current government price reporting requirements, Spark Therapeutics cannot offer installment payments or outcomes-based rebates above a certain threshold. The company has submitted a proposal to CMS to enable commercial and government payers an installment option and greater rebates tied to clinical outcomes, according to a release.

The company has reached an agreement in principle with Harvard Pilgrim to make the therapy available under the outcomes-based rebate arrangement and contracting model. It also reached an agreement in principle with affiliates of Express Scripts for the contracting model, according to the company. – by Robert Linnehan