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Cigna offers new coverage program for expensive gene therapy

Employers, health plans and unions may enroll; covered consumers have no out-of-pocket payment for medication.

Susan Morse, Senior Editor

Cigna is expanding access to expensive gene therapies through a program that allows patients to have no out-of-pocket payments related to the cost of the medicine.

Those providing health coverage, such as employers, health plans and unions, may enroll in the Embarc Benefit Protection to avoid the sticker shock of  medicines that can cost millions of dollars, according to Cigna, which did not specify the cost of the service. The company has yet to set a fee, but is aiming for it to be less than $1 per member a month, said Dr. Steve Miller, Cigna's executive vice president chief clinical officer, according to The Wall Street Journal.

Embarc Benefit Protection is the product of Cigna, its pharmacy benefit manager Express Scripts, eviCore, Accredo and CuraScript SD.

The program is starting with two therapies: Luxturna, the first FDA-approved prescription gene therapy for people with inherited retinal disease; and Zolgensma, a gene therapy for children under 2 years old with spinal muscular atrophy. Additional therapies may be added in the future, Cigna said.

WHY THIS MATTERS

Expensive therapies for rare diseases pose a new challenge for the healthcare system. This challenge will only grow as more therapies are approved by the FDA, Miller said.

Insurers are looking for innovative ways to cover the expense.

Cigna also offers the Patient Assurance Program, which caps out-of-pocket spend on insulin to $25.

CVS Health has a plan to offer coverage specifically for gene therapies, which would handle employers' costs above a certain threshold, according to the WSJ.  Anthem is looking at special insurance protection for employers.

Insurers also need to know the care outcomes resulting from expensive  therapy. Cigna said patients in its Embarc Benefit Protection program will receive personalized and expert care throughout their treatment.

THE LARGER TREND

By 2024, the cost of gene therapies is expected to reach more than $16 billion in the United States, according to EvaluatePharma.

ON THE RECORD

"All of us want innovative treatments for devastating conditions, but at an efficient affordable price," said Gene H. Price, administrator, Carpenters Health and Welfare Trust for California. "Providing our participants and dependents with access to these therapies, without sacrificing their own financial security, provides them with hope for long term health and positive life changing outcomes. Cigna now offers health plans, like our Health and Welfare Fund, a solution that will promote coverage of powerful new therapies, shield patients and families from the extreme cost, and allow families to hope for a cure and a brighter future."
 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com