Insurers try new ways to pay for million dollar drugs

Insurers and employers are scrambling to develop programs to help patients afford gene therapies that can cost more than $2 million, according to The Wall Street Journal.

One insurer, Cigna, announced Sept. 5 a new program called Embarc Benefit Protection, which allows employers and insurers to pay a monthly fee to be part of a program that covers the cost of gene therapies and helps manage their use. Under Cigna's plan, its members will have no out-of-pocket payments related to the cost of medicine.

The first two gene therapies to be included in Cigna's program are Luxturna, a one-time $850,000 treatment for an inherited form of blindness, and Zolgensma, a one-time $2.1 million treatment for spinal muscular atrophy.
Additional therapies may be added to the program later, according to Steve Miller, Cigna's chief clinical officer. Mr. Miller added that Cigna is aiming to make the program less than $1 per member per month.

CVS Health, which owns health insurer Aetna, plans to offer new coverage specifically for gene therapies. Under its program, CVS-Aetna plans to handle employers' costs above a certain threshold, according to the Journal.

CVS' new coverage options m will be available to clients in 2020 and will include Zolgensma and Luxturna and other treatments if they become available according to CVS CMO Troy Brennan, MD. He added that CVS also is working on a broader reinsurance product for other high-cost drugs.

Anthem also is looking at ways to help employers shield themselves from the cost of these drugs. Some of the ideas the insurer is evaluating are reinsurance or stop-loss programs, according to the Journal.

The plans being discussed by insurers are limited so far, according to the Journal, and it is unclear if they will be able to bring down the costs of the therapies for employers and patients. Many of the proposals may only spread out the cost of therapies into installments to be paid out over several years.

Drugmakers say they are open to working with insurers on new payment plans to boost patient access to the lifesaving gene therapies.

Read the full report here.

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