Advanced Therapy Medicinal Products (ATMPs) especially those for the treatment of rare diseases are innovative but also very expensive medicines. For payers, they constitute a new challenge. How will financing advanced therapies work in Germany? Two invited experts answered this question during the Bayreuther Gesundheitsdialog Digital.
Dr. Volker Leienbach, a representative of the private health insurance, stated that increasing drug costs were also of concern for his insurance market. He suggested ways to avoid the EU orphan drug status in Germany because he associated it with higher prices. One solution would be to lower the threshold of €50 million value of sales at statutory health insurance expense. He recommended to even abolish it altogether or at least to consider private insurance sales. Another way would be to abolish the so-called indication-slicing to increase the target population of a medicine. He supports the high requirements for the healthcare centres offering advanced therapies, and the restriction of the treatment to stationary healthcare delivery. Finally, he admitted that these measures alone were insufficient to address the problem.
Professor Herbert Rebscher, a representative of the statutory health insurance, was more positive. In his former position as chairman of the board of DAK-Gesundheit, he financed the first gene therapy, a one-time treatment. He highlighted that the long-term savings in opportunity costs amortised the threatening treatment costs. Not to mention the reduction in patient suffering. Years later, the single patient is still doing well. Cost regulation would work better if more competing innovations enter the market. He was pleased that the G-BA considered and even followed suggestions for the definition of specialised centres. Germany finally introduced these specialised centres. In the long-term, these centres could also produce individual ATMPs.
He doubted that all products in the pipeline will reach the launch and if so, predicted that existing instruments to regulate costs will be adjusted accordingly. Thus, he proposed the introduction of a “clean cost-benefit analysis” in the mid-term. Currently, cost-benefit analyses are only in theory part of the AMNOG procedure.