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As part of our comprehensive strategy for managing specialty drugs, Independence is proud to announce the establishment of our Advanced Network for Gene‑Based Therapeutics. This network ensures that our members have access to multi-million-dollar gene‑based therapies, like Luxturna®, Zolgensma®, and Skysona®, delivered in facilities that share our commitment to driving clinical outcomes and value. The facilities in this network as of March 1, 2023, are:
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- Penn Medicine
- Children's Hospital of Philadelphia (CHOP)
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Advantages
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Independence has partnered with these facilities because they are at the forefront of gene‑based therapy research and development. Their staff is trained in the protocols established by each manufacturer to get the best results. Independence works closely with these facilities to ensure that they consistently deliver patient‑centered care that meets all clinical, quality, and safety benchmarks for our adult and pediatric members.
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Coverage
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All FDA‑approved gene‑based therapies currently on the market treat ultra‑rare or rare diseases. These therapies are eligible for coverage under the Independence medical benefit. They require precertification approval to ensure that members meet the coverage criteria in our medical policies. As part of the precertification process, each member's age, physical location, and plan benefits will be taken into consideration when determining which Advanced Network facility will be approved for treatment.
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Care management wraparound
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Independence Registered Nurse Health Coaches can provide wraparound support to members who are candidates for gene‑based therapies. This dedicated team can answer questions and help members navigate all phases of diagnosis, treatment, and follow‑up care. They can also coordinate precertification reviews, facilitate member transitions into the Advanced Network, and empower health care decision‑making for members.
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Securing value
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In addition to championing member health care, Independence is focused on delivering value to our customers through ongoing enhancements to our Return-on-Recoveries (ROR) program. Our Advanced Network is just one example of this commitment. Other innovative solutions include outcomes‑based agreements (OBAs). In an OBA, the drug manufacturer provides a warranty on the cost of the drug if it does not produce expected outcomes in members who receive treatment. More details about ROR enhancements will be announced in upcoming editions of Edge.
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Looking ahead
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Over the next few years, gene‑based therapies could transform the ultra‑rare and rare disease landscape. Independence will continue to forge innovative partnerships to ensure that our members have access to these advanced treatments, delivered in best-in-class facilities that provide outstanding member‑centered care and high customer value.
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