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fit the description on the drug’s FDA label, not to drag its heels in processing claims, and to cap patient out-of-pocket costs. The question is, can Spark cut the same agreement with other insurers? Marrazzo said negotiations with additional payers are “meaningfully underway.”
Stepping back, it’s also unclear if Spark’s creative plans, even if successful, could apply to other diseases with
larger pools of patients. “The mistake would be assuming this approach could be generalized to other expensive products,” says Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York.
Harvard Pilgrim’s Sherman doesn’t necessarily see his group’s agreement with Spark as a solution to high drug prices. This “experiment,” as he calls it, is doable because of the tiny patient population. “With the number of high-cost therapeutics coming over the next five years, any one of them might have a fairly small population, but add them together and they’ll become very material,” says Sherman. To keep medicines affordable, “we’ll have to be more creative. These early experiments are a starting point.”