Aetna is launching a designated network to cover new gene therapies for rare diseases, the insurer announced Thursday.
The Gene-Based, Cellular and Other Innovative Therapies (GCIT) network, which will be included as a standard network for Aetna fully insured plans, gives members access to over 75 providers and a clinical team to guide members and providers through the care process.
The network will launch Jan. 1, 2022, and cover three gene therapies—Luxturna, Spinraza and Zolgensma—for inherited retinal disease and spinal muscular atrophy.
"We're creating a differentiated provider network that our customers can experience as being caring, connected and convenient," said Richard Gentleman, executive director of national partner strategy at Aetna, in a statement. "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."
The FDA has approved 22 cellular and gene therapies to date, most for cancers and rare diseases. Some biotech companies are working to develop gene therapies to target more common conditions, like diabetes, obesity and Alzheimer’s.
Gene therapies can come with sky-high price tags. Zolgensma, a spinal muscular atrophy treatment and one of the three therapies covered in Aetna’s new network, is the most expensive medication in the U.S., coming in at $2.1 million per course of treatment.
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Aetna expects gene therapies to add $45 billion to healthcare costs between 2020 and 2024 if the FDA approves all other therapies currently in the pipeline.
"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 Joanne Armstrong, M.D., chief medical officer of the women's health and genomics division 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."
The network is also available to self-insured plans. Aetna will provide travel and lodging support for members who have to travel 100 miles or more to receive treatment, the company said.
The network offers a financial protection program for CVS Caremark clients and Aetna plan sponsors who don’t have stop-loss insurance. CVS Health acquired Aetna in 2018 for $69 billion.