While innovative gene therapies offer effective treatments and potential cures for both rare and common genetic conditions, navigating the costly and sometimes complex treatment journey can be challenging for patients and their families.

Cigna Healthcare has designed programs to help alleviate these challenges through strategic clinical partnerships, comprehensive patient support, and innovative financial solutions.

Here are three ways Cigna Healthcare helps simplify the gene therapy treatment journey.

1. Increasing access through transformative partnerships

The Cigna Healthcare Gene Therapy Program partners with specialized facilities authorized by gene therapy manufacturers to deliver these innovative treatments to patients in need. Kirk Davis, senior manager of the program, emphasized that these partnerships are crucial to expanding access to gene therapies and ensuring patients receive the best possible care. “It’s truly a team effort to deliver our program and to partner with providers to help our patients prepare for and receive gene therapy services,” Davis said.

One of Cigna Healthcare’s key partners is the Children’s Hospital of Philadelphia (CHOP), which offers nine gene therapies to covered patients. CHOP has been involved in gene therapy development and implementation for over a decade, participating in the earliest gene therapy studies to treat hemoglobin disorders like sickle cell disease and beta thalassemia. “Our hospital is heavily committed to gene therapies,” said Dr. Tim Olson, medical director of the Blood and Bone Marrow Transplant Program at CHOP. “They are revolutionizing the lives of children with many of the rare pediatric disorders that we treat.”

CHOP had to implement specialized capabilities and new layers of infrastructure to be able to participate in clinical trials and administer these therapies, Dr. Olson said. These include streamlined workflows that facilitate efficient coordination with payers like Cigna Healthcare, such as the development of patient information templates to ensure the hospital provides all the information needed for timely approval of the treatment. “This is all possible through our conversations and active relationships with partners like Cigna Healthcare,” he said. “We can move toward approvals as quickly as possible, particularly in urgent cases.”

Davis noted that some gene therapies are available only at a limited number of places in the U.S. “While pharmaceutical companies are authorizing more and more treatment centers, some patients may have to travel several hundred or even several thousand miles to access treatment,” he said. The Cigna Healthcare Gene Therapy Program offers a travel benefit to ensure patients can receive these life-changing treatments.

2. Comprehensive patient support facilitates swift approval and effective treatment

Cigna Healthcare’s case management program helps guide patients, their families, and caregivers through the treatment journey, which for stem cell gene therapies is complex and extends over several months. “Case managers work to understand each patient’s family structure, support system, and any financial needs or barriers,” said Kristen Good, transplant case manager team lead at Cigna Healthcare. “With patients receiving gene therapy treatment, we also focus on thoroughly educating them on treatment details and potential side effects. The goal is to set the patient and their family and caregivers up for success.”

For example, Good supported a young boy who was one of the first patients to successfully undergo the new commercially approved gene therapy Lyfgenia, designed to treat sickle cell disease. The care journey for him and his family began months before treatment started, when Good reached out to help them prepare. She also reviewed the prior authorization forms for Lyfgenia with the treatment provider in advance, highlighting the specific documentation that would be needed. “When the prior authorization was submitted, we were able to approve it within just a few days,” Good said.

Good stayed in communication with the boy and his family throughout the lengthy process. It began with two inpatient admissions for stem cell collection, followed by a 2½-month wait while the personalized gene therapy was manufactured. The boy then spent more than 40 days in the hospital after receiving the Lyfgenia for close monitoring and management of side effects of the conditioning chemotherapy as the new blood cells established themselves and his immune system recovered.

“My goal as a case manager has always been to educate patients and families on all aspects of gene therapy, many of which they’ve never experienced before,” she said. “We also strive to identify any current needs they might have and help them anticipate other needs that might come up.”

Cigna Healthcare’s case management program goes beyond medical needs, also addressing mental health issues and providing comprehensive support. “Mental health is vitally important during a complex procedure like stem cell gene therapy, which can be lengthy and at times traumatic,” Good said. Case managers assess each patient using the PHQ-9 depression screening and GAD-7 anxiety screening tools. “We also guide patients toward helpful health benefits and connect them with our Evernorth Behavioral Health Care team when appropriate,” she said.

Good’s proactive engagement with the boy and his family helped ensure a smooth treatment process. “This family is amazing. They are so resilient and grateful for our support,” Good said. “He is finally getting back to himself and excitedly planning for the future.”

3. A financial solution for high treatment costs

More than half of the one-time, single-dose FDA-approved gene therapies cost $3 million or more, with two gene therapies priced at or above $4 million each. To manage these substantial costs, Cigna Healthcare offers the Embarc Benefit Protection program for plan sponsors to include in their benefit package. “Our clients pay a predictable per-member-per-month charge of $1.25,” said Preety Sharma, senior director of product strategy at Cigna Healthcare. “If a patient receives a covered gene therapy product, there is no additional out-of-pocket cost for the therapy beyond any applicable cost share of a high deductible health plan.” The plan sponsor would still be responsible for any administration costs.

The program’s design includes a unique annual surplus mechanism that delivers transparency and value to plan sponsors. “It reimburses clients a portion of the per-member-per-month charge if the total book-of-business claims utilization for gene therapies is below an established threshold,” Sharma said. This mechanism in Embarc Benefit Protection underscores Cigna Healthcare’s commitment to maintaining fairness and sustainability in its services.

Meeting the growing need

The development and use of gene therapies are expected to increase significantly, driven by a surge in FDA approvals and growing interest in these innovative treatments. “Since August 2022, when the first commercial stem cell gene therapy was approved by the FDA, we have seen an explosion in interest across the different disorders for which there are now commercial gene therapies available,” Dr. Olson said. He anticipates that gene therapy products will be involved in approximately 15% to 20% of the treatments CHOP performs over the next two years, compared to just a few cases per year today.

As gene therapy expands to offer new treatment opportunities, the Cigna Healthcare Gene Therapy Program strives to continue to ensure these therapies are accessible, affordable, and manageable. “We’ve worked diligently over the last several years to build strong partnerships with authorized gene therapy providers, and with new approvals come new relationships with new providers,” Davis said. “Gene therapies are administered in places beyond inpatient and outpatient hospital settings. Hemophilia treatment centers, physicians’ offices and home administration are now a reality.”

Embarc Benefit Protection covered two gene therapies when it launched in mid-2020 and has expanded to include 10 therapies, with expectations for further growth. “We will continue to evaluate newly approved gene therapies for inclusion in the program,” Sharma said.

Cigna Healthcare’s case managers will continue to be on hand to offer extensive support for patients and their families before, during, and after treatment. “Many patients have spent their entire lives compensating for a chronic illness, and when the symptoms of that illness are dramatically reduced or eliminated with gene therapy, it can leave a void and a need to re-identify themselves,” Good said. “We play a crucial role in preparing patients and families for this significant change, helping them develop coping mechanisms to adjust to their new, healthier reality.”

This article was created with the assistance of AI tools. It was reviewed, edited, and fact-checked by Cigna Healthcare’s editorial team and subject matter experts