Paying for Personalized Medicine

Over the course of the past two decades, few people have done more to help facilitate patient access to personalized medicine than Michael Sherman, who recently ended his tenure as the Chief Medical Officer of Point32Health, a Massachusetts-based regional health insurer. After serving New England patients and their families for 12 years at Point32Health, Sherman joined RA Capital Management earlier this month.

The field of personalized medicine expanded considerably while Sherman was at Point32Health. Between 2012 and 2020, for example, the number of medicines with biomarker strategies on their labels more than tripled, from 81 to 286. And hundreds if not thousands of newly available tests promised opportunities to detect the onset of disease at its earliest stages, pre-empt the progression of disease, and increase the efficiency of the health care system by targeting treatments to only those patients who will benefit.

Innovators in personalized medicine, however, struggled during this time, as they still do, to convince health insurance executives that paying more for tests and treatments today will decrease health spending in the future by keeping patients healthier, longer. As a result, many patients are unable to access tools that might promise to address their unmet medical needs.

Sherman pioneered ways to do better for patients insured by Point32Health.

By signing innovative reimbursement agreements with diagnostics and therapeutics developers who are willing to share in the financial risks of piloting coverage for new medical products pending proof that they can improve outcomes and reduce costs, he helped preserve healthy bottom lines for industry executives and Point32Health without sacrificing patient access to the latest medical interventions.

For Point32Health’s members, Sherman’s work has unlocked timely access to genomic profiling tests that can point patients with cancers and rare genetic diseases toward impactful targeted treatments, multi-cancer early detection tests designed to spot cancers at more treatable stages, and a gene therapy designed to address the root genetic cause of an inherited form of blindness, to name but a few of the most groundbreaking examples.

In an era too often characterized by a widening gap between what is possible and what is practiced in modern medicine, Sherman’s work reminds us that practice gaps in personalized medicine are anything but inevitable.

PMC Senior Vice President for Public Policy Cynthia A. Bens will introduce Sherman to the conference audience on November 30.

  • Introduction

    Cynthia A. Bens
    Senior Vice President, Public Policy, Personalized Medicine Coalition

  • Speaker

    Michael Sherman, M.D.
    Venture Partner, RA Capital Management