Cost and Reimbursement Assessment for a Biopharmaceutical Company
Case Study 4: Cost and reimbursement assessment
Case Study
Background
A large biopharmaceutical company developing chimeric antigen receptor T-cell (CAR-T) therapies and radiopharmaceutical therapies (RPT) for treatment of prostate cancer engaged L.E.K. Consulting to evaluate the payment and reimbursement landscape, costs by stakeholder, and value flow of patients going through CAR-T/RPT treatment in the U.S., Germany and Japan.
L.E.K.’s approach
We conducted extensive primary and secondary research to characterize the CAR-T/RPT market with respect to several key considerations, including:
- Costs to institution and patient
- Care flow steps
- Average duration on therapy
- Current pricing and access environment
- Current treatment paradigm and unmet needs
- Payer and government policies for reimbursement
We then created a detailed map of the CAR-T and RPT care flow, identified mechanisms for reimbursement in each geography, and quantified costs to the institution and patient at each step.
Value delivered to the client
L.E.K. provided support for the client’s strategic planning and presented the client with an actionable set of recommendations (see Figure 1).
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