Gene therapy is rapidly growing. There are 12 FDA-approved gene therapies to treat 143,000 potential candidates in the U.S. It’s estimated that by the end of 2026, there will be 26 additional FDA-approved gene therapies to treat more than 6.1 million people in the US.*
Anthem is closely following the evolution of this class of therapies. Most importantly, we and our pharmacy benefits manager, CarelonRx, are focused on understanding their safety, effectiveness and appropriateness. We’re assessing their alignment with our medical policies — so we can support your clients' needs with access to high quality care and cost management strategies.
Managing the costs of gene therapies
We take a holistic approach to treating rare genetic conditions by bringing together health services, medical management, healthcare data, and specialty pharmacy expertise.
Anthem’s Gene Therapy Solution (upstate / downstate) works as an endorsement of its stop loss products (upstate / downstate) to protect self-insured employers from unknown financial risk — while providing coverage and care management for your clients’ employees and their families with rare and complex conditions. There are no exclusions planned on future gene therapies that are covered by the Anthem Gene Therapy Solution.
Stay informed and stay in touch
Stay in touch with your Anthem representative. They can share the latest information about how gene therapy evolves and how our health plans can help manage costs. Please reach out if you have any questions.
* Internal analysis, CarelonRx, March 2025.