Value‑Based Contracting for Cell and Gene Therapies: A Scoping Review of Payer-Manufacturer Agreements and Treatment‑Center Considerations in USA - PubMed
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- #payer-manufacturer agreements
- #cell and gene therapies
- #value-based contracting
- Cell and gene therapies (CGTs) have high upfront costs and uncertain long-term outcomes, leading to interest in value-based contracts (VBCs) that tie reimbursement to real-world results.
- A scoping review found 23 publicly reported VBCs in the USA (2017-2026), covering conditions like spinal muscular atrophy and sickle cell disease, mostly involving Medicaid and commercial payers.
- Reported outcomes in VBCs focus on patient-level clinical milestones, such as remission status or transfusion independence, with assessment periods ranging from one month to five years.
- Contracts show significant variability in outcome definitions, timelines, and structures, with no details on adjudication processes, third-party roles, or performance results disclosed.
- Treatment centers are well-positioned to support data collection and outcome measurement, addressing implementation challenges as VBC adoption increases in CGTs.