CVS Health to Make Gene Therapy Accessible via Employer-Based Insurance

Last modified: January 17, 2020

Two million dollars per treatment — that’s the current cost of gene therapy; definitely a huge price to improve someone’s life. Considering this, gene therapy is beyond the reach of people who are struggling financially — hence why CVS Health aims to make therapy more affordable with employer-sponsored insurance.

CVS Health published a whitepaper last week stating that they will leverage their acquisition of Aetna (a health insurance firm) to lower the cost of gene therapy. In addition, CVS Health is set to release a brand-new insurance product by March that would address the financial risk of covering therapies.

According to CVS Health’s chief medical officer, Dr. Troy Brennan, gene therapy could be the hope of many a patient dealing with serious medical conditions; the impact is substantial and the results look durable thus far. 

Brennan further explained how gene therapy works. Generally, this form of treatment would replace a defective gene with a working one so the disease could be prevented. Serious illnesses such as muscular dystrophy, blindness, and leukemia are just some of the conditions gene therapy may alleviate. However, Brennan said that there are no adequate data proving just how long its effects persist or whether it’s considered a “cure.”

CVS Health estimates that gene therapy will save the US healthcare system an extra $66 billion. The greater news is there are also other companies currently working to decrease the cost of therapies; healthcare insurance providers Cigna and Anthem are some examples. The former recently launched a feature that allows its members to pay for gene therapy. Anthem, on the other hand, announced that they’re also working on ways to tackle gene therapy issues. 

Coming back to CVS Health, the company is thinking of utilizing a value-based deal model for therapies. Meaning, health plans and employers would be reimbursed partially in case the treatment fails. To achieve this, the healthcare company would employ gene therapy manufacturers. But before making a deal, CVS Health must wait for the cost of therapy set by the federal government and the Medicaid Drug Rebate Program.

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