“What is gene therapy?
To review, gene therapy aims to treat – and ideally cure – a disease by changing the patient’s genetic makeup instead of using drugs or surgery. This could involve:
- Replacing genes that are causing disease,
- Inactivating genes that aren’t functioning properly, or
- Introducing new or modified genes to help treat a disease.1
There are two types of gene therapies: in vivo (inside the body) and ex vivo (outside the body). In vivo gene therapy involves direct delivery of functional genes into a patient’s target organ. Ex vivo gene therapy, on the other hand, involves removing cells from a patient’s body and then modifying them with genetic material in a culture. The gene modified cells are then reintroduced back into the patient.”
What Does This Mean to You, the Employer?
Where Gene Therapy was just recently used, was in curing people with Hepatitis C. It was a couple years before MSP paid for this drug, and this meant the full cost was put through the Employer’s benefit plan. This cost was $25,000+ per year per insured.
It truly is great that employees and/or their dependents can be cured from these diseases. However, at what cost to your benefit plan? Do you have limitations on who can access these high cost treatments? How much does the Government Plans pay towards these therapies? These are some of the questions that you should have answers for.
Having answers to these questions will allow you to be proactive, not reactive. It is difficult to take benefits away from Employees when they are being used.
I already have clients who have seen Gene Therapy get paid through their Benefit Plan. Are you prepared for these types of expenses? Do you understand the ramifications these therapies will have to your rates? What is your exposure? Do you know your Pooling Limit on your Extended Health Plan?
If you would like to deal with a Broker who understands how this and other changes are affecting your rates and contracts, call Glendinning Insurance Services at 250-764-0142.
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