CVS Health plans to launch a new insurance product by the end of March 2020. It will absorb the astronomical expenses health plan members experience when undergoing gene therapy.
“With prices for a single treatment as high as $2 million, many employers are struggling to find ways to offer coverage without bankrupting their health plans, or even their companies.” A CVS Health spokesperson says their new insurance product will further protect employers and health plans by spreading the risk of covering gene therapy across a large pool of participants.
“Gene therapy is having a very substantial impact for patients with very serious illnesses, and the results appear to be durable. That’s why it’s important to make it as affordable as possible.”
Dr. Troy Brennan, chief medical officer for CVS Health
What is Gene Therapy?
Gene therapy replaces a faulty gene with a working one to treat or prevent disease. According to the Food and Drug Administration, blindness, muscular dystrophy, leukemia and sickle cell disease are just a few of the serious illnesses that gene therapy can mitigate.
What’s Next?
According to the company, CVS Health is utilizing its 2018 acquisition of health insurance company Aetna to spread out the cost of the treatments. Part of their solution to combat the price tag of treatments is increasing access to Aetna’s National Medical Excellence Program. The program includes a list of specialist health centers with high outcome levels at reasonable prices, as determined by Aetna.
These “Centers for Excellence are experts at this type of therapy, and they generally perform them at a higher volume than other institutions,” Brennan says. “It’s a way of ensuring the highest quality of care while maintaining consistent pricing.”
Two other health insurance companies are looking to help mitigate the cost of gene therapy. The Wall Street Journal reported that Cigna added a program in September where members pay by month for access to a feature that helps pay for gene therapy. Anthem announced they’re also developing plans that address gene therapy.
Information provided by Employee Benefit Adviser.
As more information is released, trust the Creative Benefits Team to keep you updated on pertinent industry news. Questions? Contact the Creative Benefits Team at 866-306-0200.