Prime Therapeutics launched a new initiative aimed at making it easier for its plan sponsors to shoulder the cost burden of gene therapies.
Blues plans and self-funded employers that join the new PreserveRx program will pay a per-member per-month fee and in exchange will be shielded from the extremely high one-time cost of new therapies such as Zolgensma, for now, the world’s most expensive drug.
PreserveRx is offered in conjunction with BCS Insurance Company, a reinsurance company backed by Blues plans much like Prime is.
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Patrick Gleason, assistant vice president of health outcomes, told FierceHealthcare that the initiative was born from meetings with Blues plans, which are highly concerned about the looming cost of gene therapies.
“We want to preserve access to these therapies but at the same time understand that they’re incredibly expensive,” Gleason said.
PreserveRx will apply to Zolegensma and Luxturna, two treatments that have secured Food and Drug Administration approval, as well as Valrox, LentiGlobin and GT-AADC, therapies that are expected to be approved by the FDA this year.
Gleason said plan sponsors that wish to join PreserveRx will have the option to sign on only for coverage for the FDA-approved drugs, or for all five. Prime Therapeutics intends to update the program depending on what’s in the drug pipeline.
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A critical source of data in building the tool was Prime’s research into “super-spenders,” or people who spend more than $250,000 on medical and pharmacy claims per year. The number of members in that category increased by 63% between 2016 and 2018.
As the number of costly specialty drugs—including gene therapies—continues to grow, Prime is warning that health plans and employers that the likelihood that they’ll need to prepare for these super spenders is also growing.
Gleason added that PreserveRx doesn’t solve the affordability problem for gene therapy on its own, either. Outcomes-based contracts are also a critical tool in addressing the cost.
In that scenario, a health plan would be compensated by a pharmaceutical company if the drug doesn’t meet designated safety or outcomes benchmarks. Gleason noted that products like gene therapy are approved by the FDA based on trials in a relatively small number of people.