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One-time cell and gene therapies offer promises of cures, but payment challenges remain

Roughly half a century ago, scientists first began hypothesizing that they could cure diseases by altering genes. Thanks to recent advances in the fields of molecular biology and gene editing, this hope of yesteryear has become a reality. Today, a growing number of cell and gene therapy products are being used to improve the health of patients around the world by fighting disease at the cellular level.

Most cell and gene therapy products are intended as one-time injection treatments, which in turn may offer durable cures. Until now, the overall costs - or budgetary impact to payers - of approved cell and gene therapies have mostly been manageable due to the (very) small populations being served. But this is about to change with the advent of treatments indicated for much larger populations and for much more common conditions such assickle cell disease, diabetic complications, and osteoarthritis.

However, without a feasible way for payers to pay for these treatments, patient access will remain a major impediment. In turn, this could ultimately result in a continued high societal burden for patients afflicted by diseases targeted by cell and gene therapies.

While upfront costs of cell and gene therapies can be very high on a per-unit basis, having a cure rather than a temporary and incomplete remedy or merely an alleviation of symptoms could lead to cost savings in the long run. And it’s been shown that certain cell and gene therapies may even be cost-effective in the short term, relatively soon after they’ve been administered.

But in order for this value proposition to become a more widespread accepted practice, payers must adopt a view that incorporates the concept of value-based pricing. Traditional methods of reimbursement that are commonly used for maintenance medications such as anti-hypertensives and anti-depressants, aren't applicable. As a result, payers will need to implement value-based pricing arrangements like pay-for-performance schemes or warranty programs. With these type of arrangements evidence is gathered and analyzed to assess whether a cell and gene therapy is proving effective over time—on other words, as a drug yields positive, intended outcomes for a patient, the therapy’s value is proven.

There are more than 1,000 clinical trials of cell and gene therapies underway worldwide. Consequently, experts forecast a wave of new cell and gene therapy approvals in the coming years across numerous therapeutic areas, including several with very large sub-populations numbering millions. Invariably the question becomes how patients, and the healthcare systems, will pay for these therapies.

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Lyfegen is already working with payers and pharmaceutical companies to implement value-based pricing arrangements in multiple markets. The Lyfegen Platform is designed to enable more efficient and transparent management of value-based drug pricing contracts for cell and gene therapies by using intelligent algorithms to capture and analyze real-world, patient-level drug cost data. Additionally, the Lyfegen Model & Agreement Library contains over 18 innovative models and more than 2,000 agreements from global payers and pharma that can be invaluable resources when identifying the right model to propose during negotiations.

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Why Rebate Management Deserves Q1 Attention

Reviewing Performance

Q1 is the ideal time to evaluate rebate performance from the previous year. Were the agreements aligned with expectations? Did they deliver the promised value?

By assessing past performance, teams can identify underperforming agreements and opportunities for improvement. This ensures resources are allocated to agreements that drive measurable results.

Optimizing Current Workflows

Rebate workflows are often complex, requiring significant manual effort for tracking, reconciliation, and reporting. In Q1, organizations have the opportunity to implement systems that:

Reduce administrative burdens.

Automate repetitive tasks.

Provide real-time visibility into rebate performance.

Streamlining workflows early in the year creates efficiencies that save time and resources throughout the year.

Negotiating Future Agreements

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A move to outcome-based agreements, which tie rebates to specific performance metrics.

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Teams equipped with data from previous agreements are better positioned to negotiate terms that align with strategic goals.
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The Role of Technology in Pharma Rebate Management

Technology is transforming how organizations approach pharma rebate management. Tools like those offered by Lyfegen enable teams to:

Automate workflows: Reduce manual effort in tracking and reconciliation.

Gain transparency: Access clear, real-time insights into rebate agreements.

Optimize decisions: Use data-driven analytics to evaluate and renegotiate agreements.

For example, Lyfegen’s platform simplifies rebate tracking and provides actionable insights, ensuring organizations maximize their rebate potential while minimizing inefficiencies.

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Start your year smarter!

Q1 is the time to rethink and refine your approach to pharma rebate management. With smarter workflows, clearer insights, and a focus on data-driven strategies, your team can unlock measurable savings and operational excellence.

Book a demo today to discover how Lyfegen’s solutions can simplify your rebate workflows and set you up for success in 2025.

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Rethinking Medicine Payments with Smarter Drug Rebate Management Solutions

Rising drug costs continue to challenge healthcare systems worldwide. In the UK, the proposed Voluntary Pricing Access Scheme (VPAG) and the NHS’s Accelerated Access Collaborative (AAC) are clear signals of the need for sustainable, transparent approaches to branded medicine pricing. These frameworks aim to control costs through 2028 while ensuring patient access to innovative treatments. Drug rebate management solutions are key to navigating these evolving frameworks. By automating complex workflows, providing real-time insights, and streamlining rebate tracking, these tools reduce administrative burdens, enhance transparency, and unlock significant cost savings.

Key Benefits of Modern Drug Rebate Management Solutions

Automation Simplifies Operations

Traditional rebate management involves resource-heavy processes prone to delays and errors. Modern drug rebate management solutions automate tasks like reconciliation, reporting, and contract tracking, enabling healthcare providers to focus on negotiating better contracts and ensuring compliance with policies like VPAG.

Transparency Reveals Opportunities

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Real-Time Data Drives Smarter Decisions

Access to live rebate and claims data allows stakeholders to evaluate agreement performance and adjust strategies quickly. With real-time insights, healthcare providers can ensure rebates are optimized, costs are minimized, and patient access is preserved.

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Faster Auditing Improves Accountability

Delayed reconciliation often creates inefficiencies and compliance risks. Modern drug rebate management solutions provide real-time rebate tracking and payment reconciliation, ensuring accurate auditing and faster resolution of discrepancies. These features are critical for meeting the transparency and accountability goals of initiatives like VPAG.

Why Now?

The VPAG and AAC frameworks prioritize:

Optimizing branded medicine spending while maintaining access to innovation.

Enhancing transparency for payers, providers, and the public.

Redirecting savings to high-impact therapies and improved patient care.

Modern drug rebate management solutions directly address these priorities by simplifying rebate processes, supporting compliance, and enabling healthcare providers to align with evolving regulatory frameworks.

Smarter Practices in Action

Lyfegen is an all-in-one platform designed to streamline rebate workflows, improve transparency, and deliver actionable analytics. By leveraging tools like Lyfegen, healthcare organizations can navigate regulatory changes like VPAG with confidence, ensuring efficient operations and measurable savings.

Looking ahead

As healthcare systems face rising costs and increasing complexity, adopting a modern drug rebate management solution is no longer optional, it’s essential. These tools provide the automation, transparency, and real-time insights needed to comply with frameworks like VPAG while driving cost savings and supporting innovation.

Ready to simplify your rebate workflows? Sign up for a demo today to see how smarter solutions can transform your strategy.

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