Gene therapy, a revolutionary approach to treating disease by modifying a person’s genes, is one of the most transformative developments in healthcare today. In certain cases, it can offer a cure for an otherwise deadly or debilitating disease, but it’s also one of the most expensive treatments available. A recent story in the New York Times about gene therapy for sickle-cell trait lays bare the tough decision for benefits administrators — paying for this treatment is extraordinarily expensive, the therapy can be difficult for patients to endure and there are no guarantees of success.
Though the number of people in the U.S. who have received gene therapy is still relatively small, by 2034, more than a million people will have undergone some form of the treatment. Gene therapy can be lifesaving, but costs are potentially prohibitive — ranging from hundreds of thousands to millions of dollars per case. As overall healthcare costs continue to rise, health plan sponsors should prepare for the impact of gene therapy and consider how to manage coverage without diminishing quality of care for their members.
