Dec. 9, 2024
As of Jan. 1, 2025, we’re launching gene therapy solutions for our commercial group members to support access to care while protecting against high treatment costs. To help track clinical outcomes, we may ask you for information about the effectiveness of these treatments prescribed for our members.
Gene therapy solutions involves:
- Helping members navigate through their complex care journey, including care coordination and case management support
- Tracking outcomes through results-based agreements with drug manufacturers to monitor treatments and help ensure clinical results are achieved
- Protecting members and employer groups against the financial risk of sudden high-cost gene therapy treatments
You should know: We may request outcomes information from you related to gene therapies including:
This list is subject to change. Always check eligibility and benefits first for each member at every visit. This step confirms membership and other details, such as prior authorization requirements and utilization management vendors, if applicable.
If your patients have questions about their benefits, they can call the number on their member ID card or log in to Blue Access for MembersSM.
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The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a provider. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.