FDA Approves New Gene Therapy Drugs for Sickle Cell Disease

FDA Approves new Gene Therapy Drug for Sickle Cell Disease

Today, the U.S. Food and Drug Administration approved two milestone treatments, Casgevy and Lyfgenia, representing the first cell-based gene therapies for the treatment of sickle cell disease (SCD) in patients 12 years and older. Additionally, one of these therapies, Casgevy, is the first FDA-approved treatment to utilize a type of novel genome editing technology, signaling…

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9th Drug Added to Gene Therapy Protection

Cell and gene therapies are curative treatments for diseases such as immune deficiencies, Hemophilia, Leukemia, and more. However, they are also incredibly expensive and potentially catastrophic for self-funded health plans. With our Gene Therapy Protection, Excess Reinsurance can help reduce our clients’ financial risk related to the therapies and put employers in a position to…

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ACA: Summary of Benefits and Coverage Requirement

The Affordable Care Act (ACA) generally requires group health plans and health insurance issuers that offer group health coverage to prepare and distribute to plan participants and beneficiaries a brief standard summary of the plan’s benefits and coverage. This summary is called the summary of benefits and coverage (SBC). In order to help employers fulfill…

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FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19)

 Q1. Do catastrophic plans currently include coverage for the diagnosis and treatment of COVID-19?  A1. Yes. Catastrophic plans must cover the essential health benefits (EHB) as required by section 1302(b) of the Patient Protection and Affordable Care Act (PPACA), subject to certain limitations. However, the exact coverage details and cost-sharing amounts for individual services may…

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Single-Payer Health Care: Is the Administrative Savings Argument Smoke and Mirrors?

The latest in our Insights from the Experts series explores the single-payer health care debate, the administrative costs of Medicare versus the private insurance market, and potential impacts on the quality of health care in the US. Advocates for a centralized single-payer health care system like Medicare-for-All often claim that Medicare, a government-run system, has…

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IRS Affirms Employer Mandate Enforcement Efforts

August 20, 2019 On June 28, 2019, the IRS sent a letter (number 2019-0008) to Senator Susan Collins, reaffirming that they will continue enforcing the employer mandate. Senator Collins, on behalf of several of her constituents, had written to the IRS asking whether the IRS might waive or reduce employer mandate penalties based on hardship…

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Gene Therapies

Gene therapy has the potential to have a significant impact on health care costs by decreasing the lifetime expenses associated with organ transplants, hospital stays, and cancer and chronic disease treatments. For example, average undiscounted lifetime health care costs for a 45-year-old with sickle cell disease have reached $953,640. Meanwhile, a 2016 analysis in the…

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The Legislative Landscape

As presidential candidates gear up for the 2020 elections, health reform (including single-payer systems) will continue to be an overarching and important topic of debate. At the same time, more immediate discussions are shaping benefits compliance trends now, such as expansion of health reimbursement arrangements (HRAs), the constitutionality of the Affordable Care Act (ACA), and…

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The Pharmacy Scene

The 2018 pharmacy benefits landscape was dominated by mergers, acquisitions, and disrupters. There was unprecedented consolidation between Pharmacy Benefit Managers (PBMs) and health plans. As of this spring, five corporate giants in the health industry will control health insurance and pharmacy benefits for more than 125 million Americans across Medicare, Medicaid, and employer- based insurance.…

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