Optum: How payers can prepare now for wave of CAR-T therapies

Health plans and pharmacy benefit managers need to be preparing now for the next wave of high-priced specialty drugs coming through the drug development pipeline, according to a new report.

Optum has released its quarterly analysis of the drug pipeline, and in it highlights three drugs to monitor, including one that is part of the trend of chimeric antigen receptor T-cell (CAR-T) therapies coming to market.

CAR-T treatments for cancer are costly but are proliferating as they offer a potentially curative treatment for the disease. Through CAR-T therapy, a patient's cells are modified in a lab and then reintroduced to the body to attack the cancer.

One of the report's drugs to watch, Tecartus, is the first CAR-T therapy designed for mantle cell lymphoma and comes in at a list price of $373,000.

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Bill Dreitlein, senior director of pipeline and drug surveillance at OptumRx, told Fierce Healthcare that it's critical for insurers and PBMs to consider a few key elements as they prepare for coverage of these therapies. For one, he said, these are not simple pills but complex and high-touch treatments, so understanding how intensive CAR-Ts can be is key to building a coverage strategy.

A member may require significant support while undergoing the therapy and must be monitored afterward to ensure he or she does not experience any adverse reactions, he said.

"You have to be aware of those things and understand the needs of that patient in that environment," Dreitlein said.

In addition, payers must have a full picture of the spectrum of treatment options and strategies in place to ensure that their members have access to the treatments they need the most. CAR-T is a great option for some patients but isn't right for everyone, he said.

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The other two drugs included in the report are Kesimpta, a treatment for the most common form of multiple sclerosis, and Monjuvi, a drug for patients with diffuse large B-cell lymphoma, the most common type of non-Hodgkin lymphoma.

Monjuvi, according to the report, is targeting a similar market as CAR-T drugs but is another type of therapy, so it may be an option that proves valuable to patients who are not good CAR-T candidates, helping them avoid treatment delays.

The drug's list price is also lower than most CAR-T therapies at $198,000.

Kesimpta, on the other hand, enters a "crowded" market in the multiple sclerosis space, according to the report. It will compete directly with Roche's Ocrevus, though analysts say Kesimpta may be an appealing option for some patients as it's administered via a subcutaneous injection, Optum said.