Gene Therapy Solutions

Keeping Costs from Mitigating Their Promising Potential.

Protection from unexpected, high-cost claims

Gene Therapy Stop-Loss offers eligible clients financial protection against unexpected, high-cost gene therapy claims.*

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Gene therapies are now a reality. These clinical breakthroughs treat and potentially cure genetic disorders that were once considered incurable. Given their remarkably high cost, however, they also present an extraordinary challenge in balancing equitable coverage and affordability.

Our gene therapy solutions help payors maintain coverage and limit financial exposure to these unique treatments. In addition to refining foundational medical and pharmacy benefit strategies, we have various approaches to help payors mitigate the financial impact of gene therapies.

In addition to financial protection programs such as Gene Therapy Stop-Loss, there are other potentially complementary approaches health plans and employers can utilize to reduce the cost impact of gene therapies including extending centers of excellence models such as Aetna’s Gene-Based, Cellular and Other Innovative Therapies (GCIT) Designated Network program, value-based contracting, and an evolution of the role of CVS Specialty to encourage direct dispensing of gene therapies to reduce costs.

Making sure gene therapy-based treatments are accessible for all those who need them requires innovative partnerships, as well as new ways of providing health insurance and pharmacy benefit design.

At CVS Health, we design programs for our clients that can help mitigate the cost impact and ensure better coverage to appropriate therapies. Such solutions, when implemented, are likely to prove extraordinarily important in helping ensure sustainable coverage and affordability throughout the health care system.

Want to learn more about how to help reduce the cost impact of gene therapies? Ask Us

*Stop-loss coverage is provided by Aetna Life Insurance Company and its affiliates (Aetna). Aetna is a member of the CVS Health family of companies.

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