BCS Financial Launches Critical Illness Policy to Cover Gene Therapies

BCS Financial, an insurance and financial services company owned by all 34 Blue Cross Blue Shield Plans, recently announced the launch of an innovative, first-of-its-kind Critical Illness rider to help consumers pay for genetic therapies.

The Gene Therapy Rider on BCS’s EssentialCare Critical Illness insurance policy can pay 100% of the policy face amount when an insured is diagnosed with a covered disease and opts to receive a gene therapy approved by the U.S. Food and Drug Administration (FDA).

The industry continues to seek answers to the challenge of financing or payment for cell and gene therapies, with no exact answer to this point in time. Solutions to date include outcomes-based contracting, risk-pooling, stop-loss and reinsurance programs, warranty payment programs, subscription-based financing, specific patient assistance programs, among others.

The projected increase in the number of gene therapies on the market, with the anticipated expensive prices, have increased the challenge for stakeholders in developing methods to afford the drugs. Even though many organizations may not currently have  gene therapy patients, there is the concern that the number may increase going forward.

EssentialCare Critical Illness provides fixed payments in the event of a covered diagnosis, and with the addition of the Rider, may provide an additional payout to help insureds pay for the cost of genetic therapy treatment. The payments, which are based on the policy’s face value, are made directly to the insured to use how they see fit.

The Gene Therapy Rider is the second innovative rider launched by BCS – in 2019, BCS was the first to offer a Severe Mental Illness Rider for Critical Illness, providing financial protection for four major severe mental health crises.

The EssentialCare Group Critical Illness policy also provides coverage for up to 35 physical critical illnesses, eight childhood conditions, and a robust set of benefits that provide financial assistance for caregiver and support services that fit today’s consumer lifestyle.

Prime Therapeutics, in partnership with BCS Financial, launched a reinsurance solution in 2020 called PreserveRx. Similar to competitor solutions, Prime’s offering charges a PMPM fee and reinsures eligible members that incur costs from two current FDA-approved gene therapies: Luxturna and Zolgensma. As additional FDA-approved gene therapies enter the market, they can be added to the reinsurance coverage for an additional PMPM fee.