Gene therapy drugs could cost healthcare $45B in the next 5 years, report says

Gene therapy drugs have the potential to relieve or cure genetic disorders that have previously gone untreated, but the price of such treatments could cost the healthcare industry as much as $45 billion within the next five years, according to a report published by CVS Health. 

Gene therapies are drugs that use a target gene which expresses protein products that cure or mitigate a disease caused by a genetic effect. 

More gene therapies, such as Novartis' Zolgensma, a treatment for spinal muscular atrophy, have been approved in recent years, but often come with hefty price tags. One dose of Zolgensma, a complete treatment, costs $2.1 million. 

Gene therapies now in development could treat such common genetic disorders as hemophilia, muscular dystrophy and sickle cell disease. The Rhode Island-based health conglomerate's report called the price of such treatments "unfathomable."

If just 5,000 people were treated by a gene therapy drug each year and those therapies were priced similarly to Zolgensma, it would add $10 billion per year to the nation's healthcare costs, CVS Health calculated. That number is before calculating costs associated with administering the drug, and gene therapies typically require up to a monthlong hospital stay, raising its price even higher.

Estimating the exact economic impact isn't possible, because it's unclear how many patients would be treated with gene therapies or how much they would cost, but CVS Health predicted gene therapies could have a cost impact of $45 billion in the next five years. 

"These costs will hit plans — and the healthcare system — in one massive blow rather than being spread out over time," CVS Health wrote. 

And insurers tend to be hesitant to cover such expensive drugs, meaning they may be unavailable for patients who need them the most. 

"To ensure patients continue to have appropriate access to these therapies, there is a critical need for solutions to reduce the cost impact of these medications to the greatest extent possible," CVS Health wrote. 

CVS Health outlined four approaches it recommends for reducing the cost impact of gene therapies, which includes value-based contracting, financial protection programs and changing the role of the specialty pharmacy. 

Read the full report here

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