Gene and cellular therapies have life-changing potential, but they are costly and can be complicated to understand. As the pipeline expands and as plans strive to make proactive, informed decisions for their organizations, Evernorth is offering guidance to help plan sponsors navigate this complex space.
Understanding gene and cell therapy
Gene therapies are highly targeted treatments that introduce genetic material into a person’s DNA to “edit” and replace faulty or missing genetic material that leads to disease.
Cellular therapies are created by a process that involves removing cells from the patient’s body and modifying the genes of those cells in a laboratory, essentially programming them to treat or fight a specific disease. These modified cells are then introduced back into the patient’s body.
There are currently over 30 FDA approved gene + cell therapies for conditions that range from various cancers, hemophilia, sickle cell disease, Spinal Muscular Atrophy (SMA) and more.
Plan sponsors should begin to prepare as the cell and gene therapy landscape undergoes rapid evolution, with projections forecasting over 200 approvals and 100,000 treated patients in the US by 2030.
Utilize sophisticated modeling tools to understand the pipeline and its impact to plans
Some forecasting methods are more helpful than others as plans prepare for the potential impact of gene therapies. Many tools use only disease prevalence and incidence data. However, the evaluation of each individual drug in the pipeline should also consider patient demographics, disease severity, characteristics of the patient/prescriber population, and clinical trial data.
Download our discussion guide to learn more about the gene and cellular therapy pipeline and how plan sponsors can begin to prepare a data-supported recommendation for their organizations.
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