Aetna launches gene therapy network as a standard medical benefit

Joseph B. Hash

Photo: Porter Gifford/RETIRED/Contributor/ Getty Images

Aetna has announced the launch of a designated network for members to access new therapies that treat and potentially cure rare genetic diseases, while managing the high cost of these therapies. 

Over 75 designated Gene-based, Cellular, and other Innovative Therapies (GCIT) service providers are in the network. Each must meet manufacturer-specific guidelines and Aetna cost and credentialing standards.

Beginning January 1, 2022, three gene therapy services, including Luxturna, Spinraza and Zolgensma, will be in network for the treatment of inherited retinal disease and spinal muscular atrophy.  

The GCIT network is included as a standard medical benefit in all Aetna fully insured plans and is also available to self-insured plans. 

WHY THIS MATTERS

Gene therapy is the future of treatment but has associated high costs.

Aetna, which is owned by CVS Health, offers a financial protection program through the GCIT network for CVS Caremark clients and Aetna plan sponsors who do not have traditional stop-loss. 

Members and customers get a strategy to support access and manage the cost of current and future FDA-approved gene therapies, Aetna said. A clinical team  provides case management, and where applicable, travel and lodging support for members who need to travel 100 miles or more for care.

THE LARGER TREND

Since 2018, Aetna has managed Chimeric Antigen Receptor T-cell (CAR-T) services, an early genetically engineered therapy, through a long-standing transplant network department, the National Medical Excellence Program. 

An additional 120 bone marrow/stem cell transplant facilities have been designated to perform CAR-T services.

ON THE RECORD

“Gene therapy is poised for significant growth in the coming years, and the promise of durable improvement for patients with challenging diseases is exciting,” said Dr. Joanne Armstrong, chief medical officer, Women’s Health and Genomics at CVS Health. “Yet, high costs associated with these therapies continue to pose a significant challenge. It is therefore vital that they are delivered by highly-specialized providers in an environment that can provide the patient receiving the therapy a high potential of a successful outcome.”

“We’re creating a differentiated provider network that our customers can experience as being caring, connected and convenient,” said Richard Gentleman, executive director, National Partner Strategy, Aetna. “Our multi-pronged approach encompasses safety, member access to cutting-edge therapies, and cost management to support the medical and economic needs of our members and customers. It also paves the way for future FDA-approved gene therapies to be added quickly and cost-effectively so that we can help more people achieve their best health.”

Twitter: @SusanJMorse
Email the writer: [email protected]

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