News from the Blues

June 12, 2024

Gene Therapy Solutions Coming in 2025
Applies to all groups

What is Gene Therapy? It’s a new generation of drug therapies that treat rare medical conditions. While these therapies are meant to be life-changing, they are also costly (often in the millions) and may not work as intended.

What is the solution? Starting Jan. 1, 2025, our Gene Therapy Solutions will provide a comprehensive suite of stop-loss and holistic-care options.

Together with The Synergie Medication Collective^SM, this product has three key components:

1. Risk Protection
   

• Financial protection against sudden and significant high-cost gene therapies with optionality for comprehensive Blue Cross and Blue Shield of Illinois Stop Loss or a gene therapy-specific option with the BCBSIL Stop Loss GT product.
  
  
• Includes seven (or more) approved gene therapies

2. Patient Navigation (Synergie Cell & Gene+ Patient Navigation^SM)
   

• Supports members through their complex care journey
  
  
• Provides access to the best facility for treatment to help drive down total cost of care

3. Outcomes-Based Agreements (Synergie Gene+ Outcomes^SM)
   

• Comprehensive data capture and tracking to monitor outcomes and ensure clinical results are achieved
  
  
• Outcomes-based agreements to hold drug manufacturers accountable and recover a portion of the drug costs if treatment is proven ineffective

Note: Product variations are available based on market segment. Contact your BCBSIL account representative for more information.

Stay tuned for more details about this exciting new solution as we approach the Jan. 1, 2025, launch.

Synergie Medication Collective is an independent entity owned by the Blue Cross Blue Shield Association, Elevance Health, Evio Pharmacy Solutions (founded by Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Inc., and Independence Blue Cross), Prime Therapeutics^® (including Magellan Rx Management as part of Prime), Blue Cross Blue Shield of Arizona, Arkansas Blue Cross Blue Shield, CareFirst BlueCross BlueShield, HMSA, Blue Cross of Idaho, Blue Cross Blue Shield of Kansas City, Premera Blue Cross, Blue Cross Blue Shield of South Carolina, Blue Cross Blue Shield of Vermont and Wellmark Blue Cross Blue Shield.

Blue Cross and Blue Shield of Illinois contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.com   is an online resource offered by Prime Therapeutics.

BCS Financial Corporation is an independent company offering Gene Therapy Stop Loss Coverage to BCBSIL employer groups. BCS Financial Corporation administers and has sole financial responsibility for the Gene Therapy Stop Loss Coverage product.

BCBSIL makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.