A number of national health plans have created products and services to manage the extreme risk of unanticipated high-cost orphan drugs.
Independence Blue Cross (Independence) recently announced the launch of its Advanced Network for Gene-Based Therapeutics, which will be effective March 1, 2023.
The new network is designed to help members access potentially life-changing gene-based therapies from best-in-class health care providers that have demonstrated an ability to exceed quality, safety, and value benchmarks in administering gene-based therapies. These treatments provide fresh hope for patients with inherited rare genetic conditions, including a form of blindness and severe neurological and blood diseases.
The providers in Independence’s Advanced Network for Gene-Based Therapeutics include Penn Medicine and Children’s Hospital of Philadelphia (CHOP). As pioneers of these approaches, they also have staff who are experts in the protocols established by manufacturers to ensure optimal safety and the best possible outcomes when administering the therapies to patients.
Requests for gene-based therapies like Luxturna® and Zynteglo®, which are eligible for coverage under the Independence medical benefit, will continue to require precertification approval to ensure that members meet the coverage criteria in Independence’s medical policies.
Independence has Registered Nurse Health Coaches available to provide extra support to members who are approved to receive these therapies. Health Coaches, in partnership with care teams at Penn Medicine and CHOP, can assist with every step of the process, from diagnosis to post-treatment.
Independence is the leading health insurance organization in southeastern Pennsylvania. With its affiliates, IBC serves more than 8 million people nationwide. Independence’s subsidiaries provide specialty services and products including third-party benefits administration, pharmacy benefits management services, and workers’ compensation insurance.
Takeaway: Independence is pursuing outcomes-based agreements with drug manufacturers as new gene-based therapies come to market
Need current information on Blue Cross Blue Shield plans? AMI’s 145-page BCBS Plans 2023-2024 Report solves the problem of obtaining timely, difficult to obtain business intelligence on Blue Cross Blue Shield organizations.