AXS26: How Payers, Providers, and Employers View Cell and Gene Therapy Access—and Where They Agree

In an interview with Pharmacy Times, Joe DePinto, head of cell, gene, and advanced therapies at McKesson, discussed the diverging perspectives of payers, providers, and employers on funding access to cell and gene therapies (CGTs), highlighting the tension between timely patient access, reimbursement volatility, and cost-efficient health plan design. DePinto referenced a panel he facilitated at Asembia’s AXS26 Summit, which brought together stakeholders from HCA, Geisinger, and a risk-management firm to address the fragmentation of the health care reimbursement system. He noted that while perspectives diverge on approach, all parties are aligned on the urgency of solving these challenges, particularly as CGTs—historically focused on rare, smaller patient populations—rapidly expand to broader indications. DePinto also explored the promise of innovative payment models, including outcomes-based and value-based arrangements, underscoring the need for collaboration between payers, providers, and biopharma to both design and operationalize these models effectively.

Pharmacy Times: Can you please introduce yourself?

Joe DePinto: Hi, good morning. I’m Joe DePinto, the head of Cell, Gene, and Advanced Therapies at McKesson.

Pharmacy Times: Where do payer, provider, and employer perspectives diverge most when it comes to funding CGT access?

DePinto: That’s a great question about the thinking between payers, providers, and employers on CGT access. Recently, at the Asembia meeting, I facilitated a panel titled “Breaking Through Reimbursement Complexities to Enable Patient Access.” We had a great panel with folks from HCA and Geisinger, as well as an interesting company that is looking at risk management. This was part of what we discussed. When you think about it, providers want to make sure there is timely access to these therapies. Payers want to manage the volatility of single-patient case agreements in the medical benefit area. Employers want to make sure they are offering their employees the best value and the most efficient health plans they possibly can. In this emerging space with great outcomes, that is a delicate balance that needs to happen across the ecosystem.

At that panel, the conversation centered on the complexity and fragmentation of our health care system around reimbursement and how we balance all those stakeholders. One area that was clearly aligned was the importance of making progress here, because cell and gene therapy is currently focused on rare and smaller patient populations—and this space is evolving quickly toward larger patient populations, so we need to figure it out. The other area of clear alignment was around the fact that the clinical outcomes with these groundbreaking therapies are unparalleled, and we need to address that complexity so more patients can gain commercial access to these products.

Pharmacy Times: Which specific innovative payment model—annuities, outcomes-based, or stop-loss—is showing the most promise for immediate adoption?

DePinto: Innovative payment models have been a hot topic for many years. In our 2025 cell and gene therapy industry report—which we publish every October—we conducted research with both payers and providers. When we asked both groups, it became clear that they see innovative payment models as an opportunity to solve some of the reimbursement challenges. When we dug deeper into the research, approximately 60% of payers felt that innovative payment models could address some of the complexities and challenges in reimbursement. Michael Evans, the chief pharmacy officer at Geisinger, was on the panel at Asembia’s AXS26 Summit and spoke about the importance of innovative payment models. Now, when you think about innovative payment models, the considerations differ for cell therapy versus gene therapy—these are very different areas that sometimes get lumped together, but they are not the same. When new products are launched, these models are often discussed, and value-based and outcomes-based models tend to be the most popular. What they are really solving for is risk: how do we address the risk? Michael spoke about the key components of outcomes-based and value-based challenges: what are you measuring, and is there something appropriate to measure?

There are also the challenges of long-term measurement over time, because with cell and gene therapies, there is typically a cost-density component—a one-time product use with value seen over time—as well as the need to address the durability of response. It was a great conversation, and what it led to was the recognition that not only do we need to bring these innovative payment models to the forefront commercially, but operationalizing them is equally important—and that is going to require collaboration between payers, providers, and biopharma.