Insurers Propose Coverage of Expensive Gene Therapies

Large health insurers have unveiled new payment models to make gene therapies – which offer a one-time cure for patients with life-threatening and rare disease but often cost millions of dollars – more affordable for customers.

For example, 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 for sickle cell disease, thalassemias, and hemophilias.

“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. Dr. Miller added that the company hopes to keep the cost to 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.

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