20 November 2020New Captive Models

OutcomeRx launches a reinsurance product to improve access to high-cost specialty drugs

OutcomeRx, a division of CareMetx, has launched a reinsurance product to provide coverage access to high-cost specialty drugs, including therapies in the emerging cell and gene therapy market.

The Patient Access to Costly and Curative Therapies (PACCT) carve-out reinsurance product provides first-dollar coverage related to three costly therapies: Spinraza and Zolgensma for spinal muscular atrophy and Luxturna for Leber Congenital Amaurosis (LCA)—an inherited retinal disorder. It will be available with a coverage effective date of January 1, 2021.

The first-dollar coverage reinsurance product provides payers coverage without deductibles for these therapies, which is intended to reduce the cost burden on patients with SMA and LCA.

CareMetx cited estimates that by 2025, 10 to 20 new gene therapies will be approved each year. The drug cost to treat a patient with these gene therapies ranges from $850,000 to approximately $2.1 million, it said. Future cell and gene therapies are estimated to cost $2-3 million.

OutcomeRx has partnered with Crum & Forster Accident and Health and IronHealth, a division of Ironshore, to bring the reinsurance carve-out to pharmacy benefit managers, health plans, employer groups and benefit administrators.

Mark Hansan, president and chief executive of CareMetx, said: “We are confident PACCT is the most comprehensive and cost-effective reinsurance product to help protect payers from the sudden financial impact of the high-cost therapies needed to treat these rare genetic conditions.”

Brooks Wildasin, associate vice president of strategy for OutcomeRx, said: “Coverage will include a per patient per therapy cost limit for the two SMA therapies as well as for Luxturna, and be available on a per member per month basis. We believe all types of payers can benefit from PACCT, including health plans of all sizes, reinsurers, commercial group plans, and even state Medicaid plans that require financial risk containment.”