Gene-based therapies were originally developed to treat ultra-rare genetic diseases that had few, if any, treatment options. Now they are being developed to treat more common genetic diseases. These one-dose therapies can transform lives, but not all people with genetic diseases may be candidates for treatment. AmeriHealth is developing new ways to make sure these therapies are clinically appropriate for our members and administered by best-in-class providers.
Gene-based therapies are engineered in a lab using state-of-the-art technology. The main types of gene-based therapies are:
- Gene replacement therapies: Provide new copies of missing or non-functioning genes.
- Gene editing therapies: Find and repair non-functioning genes.
Gene-based therapies are eligible for coverage under the medical benefit. They require precertification approval from AmeriHealth. Each therapy has its own medical policy that lists the criteria our members must meet for coverage.
Advanced Network for Gene-Based Therapeutics*
We have established an Advanced Network for Gene-Based Therapeutics to help members get the best clinical results from these therapies. AmeriHealth members who meet medical policy criteria will be approved to receive gene-based therapies in the following Advanced Network facilities:
These hospitals have reputations for exceeding quality, safety, and value benchmarks. In addition, their staff are trained in the recommended protocols established by the manufacturer to get the best possible results. The Advanced Network has the capability to support both adult and pediatric patients. AmeriHealth works closely with these hospitals to ensure that they provide complete care that centers around the patient.
Extra support for members
Living with a genetic condition can be challenging. We have Registered Nurse Health Coaches available to provide extra support. They can assist with every step of the process, from diagnosis to post-treatment. Our dedicated team is trained to answer member questions, empower member decision-making, and facilitate connections between members and our Advanced Network specialists care team.
The future of gene-based therapies
Gene-based therapies are bringing the promise of treatment to more people. We will continue to monitor these new therapies as they move through the FDA review process. We will also work with the specialists in our Advanced Network for Gene-Based Therapeutics to ensure that members receive exceptional care and support throughout their treatment journey.