Cigna/Express Scripts Gene Therapy Solution Involves Plans ‘Pre-Paying’ For Coverage
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.
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Novel reimbursement scheme allowing payers to spread out the cost of an expensive gene therapy over time may get test drive with Spark's Luxturna before being used for big-market treatments for hemophilia.
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