Here’s how insurers are trying to keep million-dollar gene therapy costs down

By Health CareFOXBusiness

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Insurance companies are working hard to make highly expensive gene therapies more accessible, as the FDA approves more and more types of life-saving treatments.

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These new medications can cost more than $2 million per treatment, according to The Wall Street Journal.

On Thursday, Cigna Corp. announced a program, called Embarc Benefit Protection, that would protect employers from the high costs of gene therapies, while also keeping out of pocket costs low for those who are insured.

According to the FDA, gene therapies can replace problematic genes that cause certain medical problems, add genes to help the body fight certain diseases or turn off problematic genes.


However, those treatments can be extremely expensive to employers and insurers, costing hundreds of thousands and even millions of dollars.

Cigna’s program is set to begin in 2020, according to The Journal, and though it will cover just two medications at first -- Luxturna, for an inherited retinal disease and Zolgensma, for young children with spinal muscular atrophy -- it plans to add more in the future.

Similarly, CVS Health Corp told The Journal that it plans to have a specific type of coverage for gene therapies starting in 2020. It’s stop-loss program will also cover Luxturna and Zolgensma, according to The Journal.

Meanwhile, Anthem told the outlet it is trying to find solutions for protecting employers from the high costs of the treatments.

CICIGNA CORPORATION163.35+2.91+1.81%
ANTMANTHEM INC254.32+2.53+1.00%

The two medications Cigna and CVS will initially help cover, Luxturna and Zolgensma cost $850,000 and $2.1 million respectively, according to The Journal.

To keep those costs down, insurance companies are limiting who can get the treatments through review processes, the outlet reported.

Some insurance companies are also looking to payment plans, where insurers pay drugmakers for expensive treatments like gene therapies in installments, according to The Journal.

“We will deliver better care, affordability and access through this solution. Expensive therapies for rare diseases pose a new challenge for America’s healthcare system, and this challenge will grow as more therapies are approved by the FDA,” Steve Miller, Cigna's executive vice president and chief clinical officer said in a statement.


“We are leveraging our collective capabilities to deliver on the true promise of modern medicine. No cure should be out of reach of any patient, and they should receive the best quality care,” Miller added.