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Cigna/Express Scripts Gene Therapy Solution Involves Plans ‘Pre-Paying’ For Coverage

 
• By Cathy Kelly

Approach designed to avoid price “shock” when coverage for Luxturna or Zolgensma is requested. Plans would agree to certain per member per month payments to enroll in the program, which would cover both plan and patient costs for gene therapy.

Lightning-strike
Program Will Ensure Coverage When Needed

The Cigna Corp. Health Services business will launch a solution in 2020 for covering high cost gene therapies in which payers enroll and make monthly per member payments into a newly dedicated program that would cover the cost of gene therapy in the future if they have a member who needs treatment.

The program will be administered primarily by Cigna’s eviCore specialty medical management business, which is part of Express Scripts Holding Co.. EviCore will contract with employers, insurers, HMOs and...

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