Access Barriers in NMIBC: Financial, Operational and Systemic Challenges With Emerging Therapies

EP: 1.Evolving Guidelines: Impact of Gene Therapy and BCG Failure Redefinitions on High-Risk NMIBC Patient Management

EP: 2.Applying Evidence Standards to Guide Gene Therapy Use in BCG-Unresponsive NMIBC

EP: 3.Impact of Real-World Treatment Experience on Gene Therapy Uptake in NMIBC

EP: 4.Navigating Challenges and Impact on Workflow with New NMIBC Therapies in Practice

EP: 5.Effective Strategies for Clinics Preparing to Implement Gene Therapy Into NMIBC Treatment Workflows

EP: 6.Reducing Clinical Resource Burden: Impact of Less Frequent NMIBC Therapy Administration

EP: 7.How Community-Based Gene Therapy Is Changing Treatment and Improving Quality of Life for Patients With BCG-Unresponsive NMIBC

EP: 8.Understanding NMIBC and Its Risk Factors

EP: 9.Navigating Treatment Burden in NMIBC

EP: 10.When BCG Falls Short: What’s Next for NMIBC Patients?

EP: 11.A New Era: The Rise of Gene Therapy in NMIBC

EP: 12.Where Do We Go From Here? Overcoming Barriers in NMIBC Care

EP: 13.Bridging the Gap Between Clinical Trial Evidence and Real-World Practice in NMIBC

EP: 14.Coverage Criteria and Clinical Evidence Used to Shape Health Plan Formulary Decisions in BCG-Unresponsive NMIBC

EP: 15.Prioritizing Safety and Efficacy: Role of Guidelines in NMIBC Formulary Decisions

EP: 16.Evaluating Cost-Effectiveness of NMIBC Therapies From a Health Plan Perspective

EP: 17.Leveraging Real-World Evidence in NMIBC Therapy Evaluations

EP: 18.Administration Matters: How Dosing Frequency and Toxicity Shape NMIBC Coverage Decisions

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EP: 19.Access Barriers in NMIBC: Financial, Operational and Systemic Challenges With Emerging Therapies

Video content above is prompted by the following:

Health plans face multifaceted access and affordability challenges with emerging BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) treatments, spanning financial, operational and systemic barriers that complicate patient care delivery. High up-front treatment costs ranging from $100,000 to over 1 million dollars per patient create significant financial burden, while limited long-term comparative effectiveness data make value assessment difficult. Bladder cancer ranks among the most expensive cancers to manage, compounding cost concerns for both payers and patients facing substantial out-of-pocket expenses that can delay therapy initiation or reduce treatment adherence.

Coverage restrictions through prior authorization requirements, step therapy protocols and strict clinical criteria help manage utilization but may create access delays for appropriate candidates. Inconsistent definitions of BCG unresponsiveness across different clinical guidelines complicate eligibility determination, while operational barriers including specialized administration requirements and limited provider networks restrict treatment availability. Gene therapy treatments require specially trained providers and certified facilities, potentially forcing patients to travel significant distances for care and adding indirect costs to treatment burden.

Adverse event management complexity for high-cost therapies creates additional financial and clinical challenges, while limited patient and provider support for navigating authorization processes and financial assistance programs compounds access difficulties. Successful strategies to address these challenges include value-based contracting arrangements that share financial risk between payers and manufacturers, enhanced manufacturer assistance programs and improved patient selection through biomarker testing. Utilization management reform through “gold card” pathway programs can streamline access for appropriate patients, while integration of real-world evidence into coverage decisions may help validate long-term therapy value and safety profiles for emerging NMIBC treatments.