Insurers Raise Concerns About Expensive Gene Therapies Breaking Health Insurance Exchange Risk-Adjustment Program

Modern Healthcare (7/5, Tepper, Subscription Publication) reported, “Health insurance companies are concerned multimillion-dollar new gene therapies could break the $9.2 billion health insurance exchange risk-adjustment program.” CMS “tinkered with the risk-adjustment system in an effort to better account for high costs, but insurers view the modifications as inadequate in the face of costly new treatments and caution that companies may respond by downgrading benefits and provider networks.”