Getting gene therapy covered can be complicated.
"To date, gene therapy or health care services that introduce genetic material into a person intended to replace or correct faulty or missing genetic material, has been excluded from the benefits provided under our health benefit plans.
In the same statement, Weber says, "We support medical innovation, and are mindful of the extraordinary cost that is associated with discovery. We will remain committed to providing health care benefits to the participants of our plans and will continue to devote considerable time and resources to determine how to offer innovative treatments as part of our health plans, while also assuring current benefits will remain available to all of the participants in our plans.
and spoke to NBC News. "If [these drugs] all come to market with prices of $2 million, we won’t be able to afford them as families or as a nation,” Mitchell told NBC News., insurance giant UnitedHealthcare approved six requests it received for the new drug, including two requests it had previously denied. But for parents like Lauren Sullivan of McLean, Virginia, the reasoning is less important than the results.
While it's a relief to some families that they will likely be granted coverage for Zolgensma and other costly gene therapies, that leaves other healthcare providers still not providing coverage, and few alternatives for increasingly desperate families. According to the, the only other SMA treatment on the market is Biogen’s Spinraza, which costs $375,000 a year for a patient’s entire life and requires three spinal injections annually.
Allure reached out to UnitedHealthcare for a statement and will update this post accordingly when and if we hear back.
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