Many health plans are struggling over the decision to cover gene therapies, a type of medical procedure which treats diseases by manipulating genes at the cellular level. On one hand, a certain gene therapy procedure may be the only option to cure an otherwise incurable disease. On the other hand, covering gene therapy can cost a health plan hundreds of thousands or even millions of dollars. Facing possible bankruptcy, many health plans are choosing to exclude gene therapy.
Cigna has recently introduced a possible solution to this problem. Cigna’s Embarc Benefit Protection program helps health plans cover Zolgensma, a $2.1 million therapy for spinal muscular atrophy, and Luxturna, an $850,000 therapy for a retinal disease, by spreading out the cost of treatment across all health plans participating the program. Participating health plans would pay less than $1 per participant per month for the program, and Cigna would then foot the entire bill for any necessary gene therapy treatment. With this program, health plans can take advantage of predictable costs while covering cutting-edge—and expensive—treatments for their participants.
As more gene therapies are poised to be approved by the FDA in the coming months and years, other big players such as Aetna and Anthem have also stated they are exploring alternative methods of coverage.