Drug benefits patients with an inherited form of blindness

Wellesley, MA (January 03, 2018) – Harvard Pilgrim Health Care is the first health plan in the nation to directly negotiate an outcomes-based contract with Spark Therapeutics for its new gene therapy that can treat an inherited form of blindness.  

The drug, LUXTURNA™, is a one-time gene therapy for treatment of patients with a form of retinal dystrophy.  Harvard Pilgrim’s innovative contracting model with Spark Therapeutics reduces the risk and financial burden for the cost of the drug, while tying payments to both short and longer-term sight outcomes in Harvard Pilgrim members. 

“We are thrilled to be able to offer our patients access to this groundbreaking genetic therapy,” said Harvard Pilgrim Chief Medical Officer Michael Sherman.  “While this new treatment and other new therapies that are in the pipeline offer the promise of dramatic health improvements, their upfront costs are significant, which makes it imperative that we work together to find creative, value-based payment approaches that tie reimbursement level to both short-term and long-term efficacy.”

The Harvard Pilgrim/Spark Therapeutics agreement provides for a reduced net cost to Harvard Pilgrim for LUXTURNA by tying level of payment to measured improvements in patients at a 30 to 90-day interval and then again at a 30-month mark.  If the therapy fails to perform as agreed upon, Harvard Pilgrim would receive a rebate from Spark Therapeutics. 

The short and long-term measures will be based on full-field light sensitivity threshold testing scores, with a baseline to be established for each eligible patient before administration of the drug.

Additionally, the agreement enables Harvard Pilgrim to purchase LUXTURNA, which is administered during surgery, directly from Spark Therapeutics, thereby bypassing mark-up of the drug by the institution administering it.  In separate agreements with the treatment centers that will administer the therapy, Harvard Pilgrim will agree to pay them fairly for their efforts, commensurate with the type of specialized medical care that is required to deliver the gene therapy. Additionally, patients benefit as Harvard Pilgrim agrees to provide coverage for its members consistent with the U.S. Food and Drug Administration (FDA) labeling of LUXTURNA, expedite benefits processing and cap patient out-of-pocket amounts at in-network limits.

“We are excited for the opportunity to work with Spark Therapeutics on this outcomes-based arrangement that will contribute to our goal of not only ensuring access for our members but also the need to maintain affordability for all of our members” said Sherman.

About Harvard Pilgrim Health Care 
Harvard Pilgrim and its family of companies provide health benefit plans, programs and services to more than 3 million customers in New England and beyond. A leading not-for-profit health services company, we guide our members –  and the communities we serve – to better health.    
Founded by doctors nearly 50 years ago, we’re building on our legacy. In partnership with our expansive network of doctors and hospitals, we’re improving health outcomes and lowering costs through clinical quality and innovative care management.  
Our commitment to the communities we serve is driven by the passion of the Harvard Pilgrim Health Care Foundation. Through its work, low- and moderate-income families are gaining greater access to fresh, affordable food — a cornerstone to better health and well-being. 

Harvard Pilgrim Health Care
Joan Fallon
(617) 509-7458