The Premera Approach to Gene and Cell Therapy
Premera Blue Cross and other Blue Cross Blue Shield plans across the United States launched a new organization called Synergie Medication Collective to lower specialty medication costs, including gene and cell therapies.
Gene therapy (GT) is a technique that uses a gene or genes to treat, prevent, or cure disease or medical disorders. GT offers the promise of potential cures but it comes with unprecedented costs ($2M to $4M per treatment). Recent clinical trials show exceptional results.
Self-funded large groups with LifeWise Assurance Company (LWAC) stop-loss coverage have Synergie Gene/Cell Therapy Risk Protection included as part of their policy. It will apply to the employers’ individual stop-loss (ISL) deductible. This protection program enables these employers to cover GT treatments under their medical plan. Thanks to this benefit, these self-funded groups have the following:
- No separate ISL for gene therapy claimants
- No lasers associated with this coverage
- No maximum on the coverage level above the group’s ISL deductible
- No need to exclude gene therapy as a covered benefit
Ingredient cost is the largest cost driver in gene therapy and the Synergie Gene/Cell Therapy Risk Protection is designed to provide coverage for the ingredient cost only. This coverage design makes LifeWise stop loss a great fit for employers who need stop-loss coverage and want to cover gene therapy but are hesitant due to costs.
Explore the basics about gene therapy in our Healthcare Asks: What are gene therapies video.
To find out more about Synergie Gene/Cell Therapy Risk Protection, contact your LifeWise Assurance Company representative.