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How to Pay the High Price

Health insurers in the US are developing new ways to pay for high-cost gene therapies, the Wall Street Journal reports.

Newly approved gene therapies come with high price tags: Spark Therapeutics' Luxturna, which treats retinal dystrophy, costs $425,000 per eye, while Novartis' CAR-T therapy Kymriah for acute lymphoblastic leukemia costs $475,000 and Kite Pharmaceuticals' Yescarta for large B-cell lymphoma costs $373,000. The most expensive so far, though, is Novartis' Zolgensma, a one-time treatment for spinal muscular atrophy, which comes in at $2.1 million.

Insurers, especially in the US where patients may move from insurer to insurer, have been struggling with how to pay for these treatments. Companies making the therapies as well as pharmacy benefit managers have floated the ideas of installment payments, alternative payment schemes, and adjusting the cost based on how well the treatment worked.

The Journal reports that Cigna is to announce a plan that would enable employers and insurers to pay a per-month fee to cover the cost of gene therapies, while CVS Health is to coverage specifically for gene therapies that would apply if employers' costs rise above a certain point and Anthem is examining a special insurance setup to cushion the treatments' costs.

"You have all these new products coming to the market at these very high prices," Steve Miller, Cigna's chief clinical officer, tells the Journal. "Clearly this is a pain point in health care that needs to be solved."