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The Premera Approach to Gene and Cell Therapy

November 16, 2023

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.