County to expand gene-therapy coverage despite higher PMPM cost to limit catastrophic exposure
Consultant recommended expanding the county’s gene-therapy coverage list from 5 to 15 drugs, raising the per-member-per-month cost from $1.99 to $4.75 and adding roughly $88,000 annually to fixed costs but reducing the county’s exposure to very high-cost claims.
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George Haron told the commission that gene therapies pose an outsized risk to the county’s self-funded plan because single treatments can cost in the hundreds of thousands of dollars. "These drugs are incredibly expensive you know they start around $350,000," he said, and described the vendor offer to expand covered therapies from five to 15 for an increased PMPM charge.
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