Understanding gene therapies
Gene therapies are transforming the pharmacy industry in more ways than one. In order to navigate these new-to-market therapies confidently, you need trusted resources and data.
Read on to better understand the impact of new gene therapies on your member population—and what you can do about it.
Gene therapies are innovative, highly targeted medications that can edit genetic material in a patient’s affected cells and tissues. They have a long history of research and development, and the availability of genetic therapies for both rare and common genetic conditions is about to take off.
Payment models and patient care systems need to be thoughtfully reimagined and strategically implemented, where it makes sense, to make gene therapy accessible for individuals who would otherwise lack access to these life-changing and life-saving innovations.
Evernorth helps our clients navigate through this complex emerging landscape. We'll be your guide from pipeline tracking and planning for your impact through distribution and management solutions.
30x
the median U.S. household income is spent per person1
$5B
to research and develop a gene therapy2
$50B+
forecasted gene and cell therapy costs in the U.S. by 20313
Preparing for the impact of gene therapies
Gene therapies are quickly coming to market, and with them the potential for life-changing outcomes for some of the most debilitating conditions patients face. With these new innovations, however, come complexities for patients, their caregivers and payers.
Gene Therapies discusses what you can do to prepare now and how Evernorth’s suite of solutions and services can set you up for success.
Gene therapies, today and tomorrow
By supporting and encouraging evidence-based access to gene therapy, payers and other segments of U.S. society will be positioned to benefit from future advancements and biopharmaceutical breakthroughs that drive systemic change.
Understanding the basics on cell and gene therapy
Gene therapies 101
We answer our clients’ burning questions about gene therapies, including how they work, whether or not they’re safe, and if we’ll see more in the future.
Understanding gene modification and cellular therapies
Gene modification and cellular therapies are unique, potentially curative treatments that leverage gene-altering technology
How to have a data-driven discussion on gene and cellular therapies
As the number of approved gene and cellular therapies grows, you can start preparing your organization now by taking the right next steps.
Understanding the gene therapy landscape
Explore the tabs for more information on gene therapies to help make impactful, informed decisions.
The need for coverage
Plans have a spectrum of coverage options to consider with the influx of novel gene and cell therapies. By offering proactive and comprehensive coverage, plan sponsors can reduce their own risk and control costs while ensuring their members have access to these groundbreaking treatments.
Have this conversation with your Evernorth account team soon.
Equip your decision makers with the right resources, pipeline insights and sophisticated modeling tools, so you can develop a clear vision for how your organization will handle gene therapy coverage. Your plan will need the right protection from million-dollar price tags, as well as a path to expand coverage for members.
Cost management
Each year comes with a new wave of approvals to plan for. Planning now for your approach to gene therapies will help you manage costs more predictably in the future.
Expanding access
Making a coverage plan for gene therapies supports health care technology that can engineer bodies to fight cancer and reverse rare diseases—all while giving hope to so many who didn’t have it before.
Competitive benefits
Including gene therapy coverage in your benefits can help set your organization apart by illustrating your strong commitment to the health of your employees and their families.
Making the gene therapy pipeline actionable
Developing a well-informed, proactive approach is critical for plan sponsors to assess their potential exposure to gene therapy. Every population is different, and the pipeline will continue to grow.
Plan-specific forecasting tools keep you informed of future impact to your members, because gene therapies are no longer only for rare cases.
Nearly a quarter of the current pipeline will affect large populations and therapy areas—including cardiology, metabolic disorders, neurology and rheumatology.4
50-75
gene cell therapies expected to be approved in the U.S. by 20305
1,000+
gene and cell therapies currently in development5
10X
The $5.2B gene and cell therapy market is estimated to grow tenfold by 20313
Each drug’s expected utilization should be evaluated based on patient demographics, disease severity, client-specific mix and clinical trial data and literature. Sophisticated forecasting models that assess these areas provide a better estimate of potential gene therapy utilization than traditional tools.
Removing the burden for patients and plans
Gene therapies and the conditions they treat are distressing enough without the added challenge of coordinating care and benefits. Faced with a rare condition diagnosis, some patients try to navigate the health care system themselves. It’s a complex and confusing journey where many struggle to understand their coverage and options.
7.6
years is the average time it takes to receive a diagnosis for a rare condition, a duration that can feel like a lifetime when searching for answers6
Supply chain pharmacy technology
Not just any specialty pharmacy is up to the task of managing and handling the fulfillment of gene therapies. Companies rely on robust supply chain capabilities to properly preserve and regulate products as they travel to the patient.
More access, plus extra care
Evernorth is home to the only specialty pharmacy with access to the majority of approved gene replacement therapies to date—and one of a few pharmacies with experience in handling, packaging and shipping these sensitive medications.
Leading distributor
As the first and only distributor of the first approved gene replacement therapy, CuraScript SD offers a unique model to satisfy the high-cost, complex fulfillment needs that go along with these therapies.
It’s in our DNA to help members live their best lives. We understand the complexities that make it difficult to coordinate gene therapy care and coverage for both plans and members. Let us guide you.
Sources
- National Bureau of Economic Research “Estimating the Financial Impact of Gene Therapy in the U.S.” April 2021.
- Innovative Genomics Institute “Paying for CRISPR Cures: The Economics of Genetic Therapies” December 16, 2019.
- GlobeNewswire “Gene Therapy Market Surges to USD 50.6 Billion by 2031, Propelled by 26.88% CAGR - Verified Market Research®"
- Tufts Medical Center CBSD.
- Milken Institute “Cell and Gene Therapies: Looking Ahead to 2022” January 4, 2022.
- Global genes “Rare Disease Impact Report: Insights from patients and the medical community” April 2013.