Experience the groundbreaking advancements in rare disease medicine with the approval of the first two gene therapies by the U.S. Food and Drug Administration (FDA) in 2017 and 2019. The approval of Zolgensma® (onasemnogene abeparvovec-xioi) for the treatment of spinal muscular atrophy marked a milestone in the transformative power of gene and cell therapies to combat terminal conditions. This approval brought hope for the future of patients facing life-threatening genetic diseases.
Independence Blue Cross (IBX) seized the opportunity presented by gene therapy by establishing the Advanced Network for Gene-Based Therapeutics in 2023. This network provides adult and pediatric patients access to life-changing gene-based therapies at cutting-edge facilities focused on research, training, and administration. Trained staff ensure that patients receive the best possible care following recommended protocols set by manufacturers.
While the potential of gene therapy is immense, the high cost of these therapies poses a challenge. With most gene therapies priced at over $2 million, the financial burden extends beyond the cost of the therapy itself.
Understanding the concerns of self-funded employers, IBX has developed strategic solutions to navigate the financial risks associated with gene therapy. By preparing for unexpected claims, ensuring quality care and support, and containing costs, IBX aims to provide effective solutions for employers.
Empowering Employers with Gene Therapy Solutions
With 11 FDA-approved gene therapies available and more in the pipeline, IBX emphasizes the importance of comprehensive cost-control strategies to minimize risks for self-funded employers. Through collaborative efforts, IBX offers innovative solutions to help employers anticipate and manage the costs of gene therapy while prioritizing quality care for their employees — our members.
Key Strategies:
- Stop Loss Coverage: Recommending stop loss coverage to provide an additional layer of protection for self-funded employers.
- Manufacturer Discounts and Outcomes-Based Agreements: Securing discounts at local facilities along with negotiating outcomes-based agreements with manufacturers to control rising therapy costs.
- Care Management Wraparound: Collaborating with medical experts to provide high-touch care management for patients undergoing gene therapies, ensuring holistic support throughout the treatment journey.
Looking Ahead
The future of gene therapy holds promise for patients with rare diseases, with the potential approval of additional therapies targeting common diseases on the horizon. As the landscape evolves, IBX remains committed to helping employers navigate the complexities of gene therapy claims and deliver exceptional care.
To discover more about our cost-saving strategies and how we can assist you in preparing for future gene therapy challenges, please contact us today.
