Insurers Introduce Plans to Cover Expensive Gene Therapies

Gene therapies – which may offer a one-time cure for patients with life-threatening and rare diseases– are among the most expensive treatments in the world, often costing millions of dollars. To help make the costs of these therapies more manageable, large insurers are proposing new payment models to eliminate out-of-pocket costs for customers.

“You have all these new products coming to the market at very high prices. Clearly this is a pain point in health care that needs to be solved,” said Steve Miller, MD, chief clinical officer of health insurer Cigna.

Cigna has rolled out a new plan that allows employers to pay monthly for a service that would eliminate out-of-pocket payments for patients receiving gene therapies. The program covers Spark Therapeutics’ Leber congenital amaurosis therapy voretigene neparvovec ($850,000) and Novartis’ spinal muscular atrophy treatment onasemnogene abeparvovec ($2.1 million). It will potentially include more gene therapies as they become available, including gene therapies for sickle cell disease, thalassemias and hemophilias. Dr. Miller says the company hopes to keep the cost employers for this new service to under $1 per member per month.

In addition, CVS Health and Anthem are both planning to offer coverage that will help protect employers from the high cost of these treatments.

“The new options may prove attractive to employers that aren’t big enough to absorb the cost of the new drugs and don’t have existing stop-loss insurance that would cover them,” said Nadina Rosier, head of the pharmacy practice at advisory firm Willis Towers Watson.

Sources: Reuters, September 5, 2019; The Wall Street Journal, September 5, 2019.