Gene Therapy

Healthcare is more than coverage alone. It is being there when people need you most and helping in ways they never imagined while keeping our commitment to affordability for employers.

Emerging gene therapies show great promise for treatment of difficult rare conditions but at significant cost. Our Gene Therapy Solution works as a provision of our stop loss policy to protect employers from unknown financial risk while providing access to robust care management for individuals with rare and complex conditions.

Our Gene Therapy Solution delivers access to transformative gene therapies
with financial risk protection

Unlocking breakthrough gene replacement therapies
Learn about gene therapy

Gene therapy is an evolving treatment for rare disorders caused by a missing or faulty gene and may involve addition, inhibition, editing, or replacement of a gene. Gene therapies can be one-time treatments that target the genetic root cause of diseases.

More than 25

new gene therapies to
receive FSA approval each year by 20262

More than $4 million

in potential costs of
a single claim3

Up to $40 billion

in estimated gene therapy
costs by 20321
1 Institute for Clinical and Economic Review (ICER): Managing the Challenges of Paying for Gene Therapies (April 2024): https://icer.org.

2 Carelon: Q2 2004 CarelonRx Drug and Biologic Pipeline Update (May 23, 2024): carelonrx.com/perspectives/2024-q2-carelon-rx-drug-biologic-pipeline-update.

3 Projection based on retail drug cost and possible additional expenses as a result of receiving treatment.

4 American Society of Gene + Cell Therapy (ASGCT): Gene, Cell, + RNA Therapy Landscape Report: Q1 2024 (accessed July 2024): asgct.org.

Stop Loss coverage is underwritten by Wellpoint Life and Health Insurance Company. Wellpoint is a registered trademark.

1043338MUEENWLP Rev. 7/24

To learn more about our Gene Therapy Solution, contact your Wellpoint representative.

Together, we can make a difference in improving health outcomes for your
employees while protecting your business from the high costs associated with
rare and complex conditions.

Future gene therapies include treatments for blood disorders, such as hemophilia, sickle cell anemia, and other diseases.

Wellpoint will monitor developments in gene therapies as we continue to advocate for high-value treatments for employees while controlling costs for employers.

The future of gene therapy

What treatments are covered 2

This Gene Therapy Solution includes emerging FDA-approved clinical treatments with strong potential for high effectiveness in treating difficult rare conditions. These drugs are mainly administered in hospitals as infusions, so they fall under the medical benefit instead of the pharmacy benefit.

Covered therapies for rare and complex conditions

Select each treatment to learn more.

Luxturna®

Skysona®

Zynteglo®

Zolgensma®

ElevidysTM

RoctavianTM

Hemgenix®

Wellpoint continually monitors promising FDA-approved gene therapies to include for coverage and offers financial protection for ASO employers specific to these therapies.

Source: U.S. Food & Drug Administration: fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/approved-cellular-and-gene-therapy-products.

Lyfgenia™

CasgevyTM

LenmeldyTM

BeqvezTM

Control
future risk

Access breakthrough
treatments

Avoid costly new lasers
in the future

Why this coverage is important

Covered therapies for rare and complex conditions

Wellpoint continually monitors promising FDA-approved gene therapies to include for coverage and offers financial protection for ASO employers specific to these therapies.