Gene therapy explained: Benefits and cost considerations
Genetics control every biological thing about us. Our hair texture, eye color, height — even our risk for disease. Genetic diseases historically have limited or invasive treatment options, resulting in poor health outcomes. Cutting-edge treatments, such as gene therapy, aim to eliminate specific genetic disorders but often come at a high cost.
As Wellmark Blue Cross and Blue Shield continues to cover treatments for our members, we also maintain our commitment to managing health care affordability for our members and customers.
What is gene therapy?
Gene therapy is used to treat or prevent the progression of genetic disorders and diseases caused by genetic mutations. These mutations result in missing or ineffective proteins in the DNA, increasing the chances of a disease or genetic condition.
What does gene therapy treat?
Gene therapy is used to treat rare genetic disorders, including:
- Blood disorders like sickle cell disease, hemophilia and thalassemia
- Neuromuscular diseases like muscular dystrophy or spinal muscular atrophy
- Rare inherited neurological or retinal diseases
The future of gene therapy is promising and holds the potential of treating even more rare diseases and common conditions like HIV, cancers, heart failure, complications of arthritis, diabetes, cystic fibrosis and more.
How does gene therapy work?
Gene therapy replaces missing or dysfunctional genetic material with new genetic material. There are three common approaches to gene therapy:
- The missing or dysfunctional gene is replaced by a different gene.
- Functional and healthy genes are added to the body.
- Problematic, disease-causing genes are “turned off.”
The specific techniques vary, but gene therapies typically use a viral vector, a vehicle used to carry DNA or RNA into the cell, to change the way the cell functions. Vectors directly target the cause of a disease.
While gene therapy has shown significant promise in the treatment of several diseases, the hefty price tag is a concern for many employers.
Keeping costs low for Wellmark employer groups
The cost of a single gene therapy treatment can range from $2.8 million to nearly $22 million, and annual spending on gene therapies is estimated at $20.5 billion. Wellmark is prepared to curb the costs associated with gene therapy and reduce actuarial risk. Here's how we’re doing it:
Get the gene therapy facts and figures
Download our pharmacy trend alert to learn about the currently approved gene therapy treatment options. Gain a better understanding of each option, including eligibility estimates, cost considerations and more.
Wellmark is here for you
As the gene therapy field continues to expand and change, Wellmark is evaluating ways to manage costs so Wellmark members can get the care they need, when they need it.
We want to make sure you know how to answer questions your employees may have about gene therapy coverage and treatment. Contact your authorized Wellmark account representative or email us at blueatwork@wellmark.com to get your questions answered.