November 9, 2023
Premera Blue Cross and other Blue Cross Blue Shield plans across the United States launched a new organization called Synergie Medication Collective to lower specialty medication costs, including gene and cell therapies.
Gene therapy (GT) is a technique that uses a gene or genes to treat, prevent, or cure disease or medical disorders. GT offers the promise of potential cures but it comes with unprecedented costs ($2M to $4M per treatment). Recent clinical trials show exceptional results.
Self-funded large groups with LifeWise Assurance Company (LWAC) stop-loss coverage have Synergie Gene/Cell Therapy Risk Protection included as part of their policy and will apply to the employers’ individual stop loss (ISL) deductible. This protection program enables these employers to cover GT treatments under their medical plan. Thanks to this benefit, these self-funded groups have:
- No separate ISL for gene therapy claimants
- No lasers associated with this coverage
- No maximum on the coverage level above the group’s ISL deductible
- No need to exclude gene therapy as a covered benefit
Ingredient cost is the largest cost driver in gene therapy and the Synergie Gene/Cell Therapy Risk Protection is designed to provide coverage for the ingredient cost only. This coverage design makes LifeWise stop loss a great fit for employers who need stop-loss coverage and want to cover gene therapy but are hesitant due to costs.
Learn the basics about gene therapy in our Healthcare Asks: What are gene therapies video.
To learn more about Synergie Gene/Cell Therapy Risk Protection, contact your LifeWise Assurance Company representative.