Back in late 2022, MedBen spotlighted the growth of gene therapy, a transformative medical approach that potentially cures genetic disorders by correcting or replacing an individual’s DNA. As we noted, these therapies go beyond treatment to literally “solving the disease.”
Since we published that article, the FDA has approved an additional seven cell and gene therapies, including two last December to treat sickle cell disease… a total of 17 overall. This year alone, we could see an additional 17 approvals in the U.S. and the European Union.
However, such breakthroughs come with an extremely high price tag. Casgevy and Lyfgenia, the two sickle cell gene therapies, list for $2.2 million and $3.1 million, respectively – and that’s on top of months of medical preparation, including chemotherapy. (In 2023, five of the top 10 most expensive drugs were gene therapies.)
Forbes recently examined the tricky balancing act between gene therapy’s potential and its high cost: “[T]o succeed industry players will have to develop innovative payment arrangements. These will be critical to the long-term commercial success of cell and gene therapies due to the large per unit upfront costs of treatment.” Currently, drug makers are exploring value-based outcomes agreements in which they share financial risks with payers, such as tying them to future claims activity.
As we stated in our earlier article, at present MedBen is recommending that clients do not cover the cost of gene therapies due to their high costs as well as their potential health risks. These include infection, damage to healthy cells, tumors, and organ failure.
We will continue to update you regularly regarding gene therapy developments. But should you have any questions, contact Senior Vice President Caroline Fraker at 800-851-0907.