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It can feel intimidating to understand complex treatments and plan for rare conditions related to gene therapy, all while trying to balance cost and care holistically.

New innovation comes with new challenges.

13

There are currently 13 FDA-approved
gene therapies on the market¹ and more
new therapies coming by the end of 2024.²

1,500+

Over 1,500 ongoing clinical trials for cell and
gene therapies are currently registered.³

$20.4B

Annual spending on gene therapies
in the U.S. is estimated to reach an
average of $20.4B by 2035.⁴

UP
TO

$4.25M

The cost of gene therapy can range
from $850K–4.25M per treatment.⁵

Gene therapies can save lives but employers need the right solutions.

See how we help you balance organizational investment with individual employee support and a multi-pronged approach including protection, patient navigation and patient outcomes.

Risk Protection

Risk protection helps you put stop loss policies in place that limit claims liability and overall financial risks that come with these costly treatments. To do this, we offer what you want most: options.

Just the right coverage
BCS Stop Loss GT covers just the gene therapy cost. You can rest assured your finances are protected.

Full-picture protection
Comprehensive Stop Loss covers any claim covered and paid under the medical plan. Beginning January 1, 2025, we’ll also include a new feature promising no new laser or rate adjustments at renewal on select gene therapies — all as part of the policy. No buy-up required.

BCS Financial Corporation is a separate company offering Gene Therapy Stop Loss Coverage to BCBSTX employer groups. BCS Financial Corporation administers and has sole financial responsibility for the Gene Therapy Stop Loss Coverage product.

Patient Navigation

Gene therapy treatment is complex, and patients need clear guidance throughout the journey. We partner with Synergie Medication Collective^SM to offer Synergie Cell & Gene+ Patient Navigation^SM throughout complex care.

This innovative program provides expanded access to the best network for treatment, which also helps drive down cost of care and thoroughly support your employees. It includes providing education about what to expect on their health care journey, pointing them to social or local resources, and helping with organizational tasks like scheduling appointments. And, it includes support for all FDA-approved cell and gene therapies.

Synergie Medication Collective is an independent entity owned by the Blue Cross Blue Shield Association, Elevance Health, Evio Pharmacy Solutions (founded by Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Inc., and Independence Blue Cross), Prime Therapeutics (including Magellan Rx Management as part of Prime), Blue Cross Blue Shield of Arizona, Arkansas Blue Cross Blue Shield, CareFirst BlueCross BlueShield, HMSA, Blue Cross of Idaho, Blue Cross Blue Shield of Kansas City, Premera Blue Cross, Blue Cross Blue Shield of South Carolina, Blue Cross Blue Shield of Vermont and Wellmark Blue Cross Blue Shield.

Patient Outcomes

If the cost of treatment is managed through risk protection and improved patient navigation - the investment is worth it. So, it is essential to put value-based agreements in place that monitor outcomes and recover a portion of the drug cost if treatment is not effective.

Through our Synergie partnership, we also include Synergie Gene+ Outcomes^SM support, which uses comprehensive data capture and tracking to evaluate patient outcomes over time after receiving gene therapy.

This includes assessments at key points in the employee’s treatment, as well as monitoring and tracking even if they move to different employers. And, if at any point, treatment isn’t successful, pharmaceutical manufacturers are held accountable. This kind of tracking and monitoring helps protect the investment of self-insured employers.

Transformative solutions require innovative care. But prohibitive pricing is a real barrier. It’s often hard to see how to bring a healthy future within reach.

We’re here to help with clear, concise, measured advice.

Gene therapies are changing the health care landscape at a rapid pace. They offer hope for people with rare, hard-to-treat conditions today, and will be applicable to more common conditions as time goes on. Support your workforce and organization with the right strategies. Reach out to your representative or read our latest white paper to learn more about innovative gene therapy protections, designed to cut through the confusion and offer you flexibility and peace of mind.

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1. U.S. Food & Drug Administration, “Approved Cellular and Gene Therapy Products,” August 2, 2024.

2. Prime Therapeutics, Quarterly Drug Pipeline, July 25, 2024.

3. Oxford Global Resources, “Cell and Gene Therapies Are Hot: See What’s Steaming in the Pipeline,” Jan. 20, 2024

4. Chi Heem Wong, et al., “The Estimated Annual Financial Impact of Gene Therapy in the United States,” Gene Therapy, 30, 761–763, 2023.

5. Fierce Pharma, “Orchard sets new gene therapy price tag at $4.25M — the steepest of any drug.” https://www.fiercepharma.com/pharma/lillys-immunology-unit-scores-another-fda-nod-eczema-treatment-ebglyss