“The world’s most expensive treatment is about to hit the market” reported the WSJ last week. A gene therapy called Zolgensma for treatment of an inherited disease - spinal muscular atrophy (SMA) – was approved by the FDA. The good news, it’s used just once. The bad news, it costs $2.125 million!!!

The article went on to mention the second most expensive drug; another gene therapy called Luxturna costing $850,000. And Spinraza, that has to be taken for a patient’s lifetime and costs $750,000 for year one and $375,000 every year thereafter. Oh, my!

God forbid anyone we know has a medical condition requiring such expensive drug therapy. But when they do, will our health plans cover the cost?

More than likely, although no insurer will give a blanket guarantee. In a case like this, your doctor will work through the protocols of the medical (not pharmacy) plan.  

I also went to GoodRx, wondering if they had any information about these meds. (Like maybe I could just pick ‘em up at the corner pharmacy with a coupon for say, $500K!) I was pushed to this post about Health Care Practitioner (HCP) – Administered drugs.

It’s worth reading.

Just in case.