Aetna rolls out in-network protection for Zolgensma, different multimillion-dollar gene therapies

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Aetna is launching a delegated community to cowl new gene therapies for uncommon illnesses, the insurer introduced Thursday.

The Gene-Based mostly, Mobile and Different Progressive Therapies (GCIT) community, which shall be included as a normal community for Aetna absolutely insured plans, offers members entry to over 75 suppliers and a medical workforce to information members and suppliers by way of the care course of.

The community will launch Jan. 1, 2022, and canopy three gene therapies—Luxturna, Spinraza and Zolgensma—for inherited retinal illness and spinal muscular atrophy.

“We’re making a differentiated supplier community that our prospects can expertise as being caring, linked and handy,” mentioned Richard Gentleman, government director of nationwide accomplice technique at Aetna, in a assertion. “Our multi-pronged strategy encompasses security, member entry to cutting-edge therapies, and value administration to help the medical and financial wants of our members and prospects. It additionally paves the best way for future FDA-approved gene therapies to be added rapidly and cost-effectively in order that we will help extra folks obtain their finest well being.”

The FDA has authorised 22 mobile and gene therapies thus far, most for cancers and uncommon illnesses. Some biotech corporations are working to develop gene therapies to focus on extra frequent situations, like diabetes, weight problems and Alzheimer’s.

Gene therapies can include sky-high worth tags. Zolgensma, a spinal muscular atrophy remedy and one of many three therapies coated in Aetna’s new community, is the most costly treatment within the U.S., coming in at $2.1 million per course of remedy.

RELATED: How CVS Well being is addressing the price of gene therapies

Aetna expects gene therapies so as to add $45 billion to healthcare prices between 2020 and 2024 if the FDA approves all different therapies at present within the pipeline.

“Gene remedy is poised for vital development within the coming years, and the promise of sturdy enchancment for sufferers with difficult illnesses is thrilling,” mentioned Joanne Armstrong, M.D., chief medical officer of the ladies’s well being and genomics division at CVS Well being. “But excessive prices related to these therapies proceed to pose a major problem. It’s due to this fact very important that they’re delivered by highly-specialized suppliers in an surroundings that may present the affected person receiving the remedy a excessive potential of a profitable end result.”

The community can be accessible to self-insured plans. Aetna will present journey and lodging help for members who should journey 100 miles or extra to obtain remedy, the corporate mentioned.

The community presents a monetary safety program for CVS Caremark purchasers and Aetna plan sponsors who don’t have stop-loss insurance coverage. CVS Well being acquired Aetna in 2018 for $69 billion.

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