How insurers are grappling with million-dollar therapies

New gene therapies are carrying price tags in the millions, leaving insurers scrambling to figure out how to cover them and offer the treatments to enrollees, according to The Wall Street Journal. Drugmakers say they are willing to work with insurers to ensure patient access to the new gene therapies, but the high cost––as much as $2.1 million for one new gene therapy treatment––threatens the financial health of employers and patients alike.

One big insurer, Cigna, recently announced a new program allowing employers and insurers to pay per-month fees to cover most of the costs of these new, pricey gene therapies. CVS Health has also come out with a new plan for covering gene therapies, offering a “new layer of coverage” for the expensive treatments that would take on the cost of an employer once it hits a certain threshold. And Anthem is looking at ways to protect employers from the fallout of the costly gene therapies, the WSJ reported.

However, the approaches could simply spread out the cost of the new therapies rather than bring down the prices, and the protections plans are limited, the WSJ noted.

Medicare recently announced it would cover an expensive gene therapy used to treat cancer in some circumstances.

See the full story below:

Amy Baxter

Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."

Around the web

A string of executive orders from the White House created serious concerns among radiologists and other healthcare providers throughout the United States. The American College of Radiology issued a statement to help guide its members through the chaos. 

Bridgefield Capital, founded in 2015, has previously invested in such popular brands as Cirque Du Soleil, Del Monte and Quiksilver. This transaction is expected to be completed in the second half of 2025. 

Given the precarious excitement of the moment—or is it exciting precarity?—policymakers and healthcare leaders must set directives guiding not only what to do with AI but also when to do it.