Somatic gene therapy (gene editing that only affects the patient and is only used for medical purposes) is very expensive (ranging from $500k to $1.5m USD). Should somatic gene therapy be available to everyone regardless of wealth?
Gene therapy is the result of technological advancement in the medical field which focuses on editing the genes by replacing, substituting, or deleting (genetic engineering methodologies). A human body is made up of genetic materials passes down the linage.
This genetic information passed down from our ancestors decides everything that happens in the human body which decides the most basic to most complex functioning. If these genes, due to various factors, become defective, the whole human body’s physiology changes, and the body is adversely affected. Gene therapy aims to eradicate or even mitigate the effects of such genetic disorders by replacing the defective genes themselves.
This medical practice has two major divisions: somatic gene therapy and germline gene therapy which focuses on body cell therapy and gremlin gene therapy which focuses on editing the genetic material of sperms or eggs and is thus passed down to their offsprings. Somatic gene therapy is not a permanent genetic change in the linage but affects only the individual receiving the therapy.
As this technology involves placing the gene in the body cells and is not passed down to the patient’s descendants, it is less controversial than genetic therapy in germline cells. Somatic gene therapy is more like a medical interaction or even a drug delivery system in the body that helps mitigate and eradication the disease in more than cosmetically beautifying humans.
Gene therapy, as a new drug delivery methodology, is increasing its popularity since the first attempt made by Martin Cling in 1980. Different types of somatic gene therapies have been researched to find treatment for inherited diseases and also for diseases that are not primarily caused by my inhabitation of fault genes like AIDS. The success in these fields has made somatic cell gene therapy less controversial and more widely accepted.
How is somatic gene therapy a medical necessity and not a cosmetic necessary?
Somatic gene therapy is done by inserting a normal functioning gene into the somatic cells of the affected individual. The simplest method is to deliver the correct genome sequence into the body through vectors like bacterial DNA, viruses, or liposomes. The cells to be targeted are usually bone marrow cells or affected tissues. These wrongly sequenced somatic cells take up the normal functioning genomic material.
When the cells intake the proper sequenced gene material, it starts instructing the body to produce the necessary enzymes, hormones, etc properly and this a proper physiological balance is produced. This procedure is changing the method of treatment of various diseases and treatment of previously incurable diseases is under research using this.
This technique treats the cause of the problem rather than mitigating the symptoms that surface on the body. Early somatic gene therapy treatment also causes less risk of causing a complication. This method has been seen as a less side effect causing the method of treatment with better results compared to the use of heavy drugs and invasive treatment methods.
Should this medical necessity cover by insurance?
Gene therapy requires more time, energy, and manpower and is more complicated than any other medical procedure that we’ve seen. It works with the minutest particles in our body which require a highly coordinated methodology to be followed and cohered between labs, pharma, patients, and medical care providers. This causes an extremely high price tag for genetic therapies.
It ranges from a few hundred thousand dollars to millions of dollars for a single treatment. The technology to conduct this procedure is highly expensive with not many skilled enough individuals. Many gene therapy treatments are still developing under research but these under research therapies are expected to surpass the current price tag by a huge margin.
This expensiveness of this medical care facility makes it impossible for the majority of the people to get this treatment which raises a debatable question, “ Should health insurances cover it?” The answer to this question is yes, they should.
The most important reason for health insurance, private or government, to help patients pay for this health expense because their primary aim is to improve the health condition of the people. Uplifting the health standards of society will benefit the nation as a whole by uplifting the living condition.
Health insurance will gain a lot of profit over the years through different treatment payment options. This ensures long term commitment from the patients due to the extremely high cost and also a regular source of income, a combination most of the insurance providers search for.
Genetic therapy is also a more certain way of treatment compared to other invasive methods or the use of heavy drugs. It is almost like a one-time investment that will cater to all his or her life if the therapy works. The insurance and the patient save up a lot of costs if compared to the larger picture.
How can insurance cover the high price tag of somatic gene therapy?
Insurances have already started modifying the methods of payment to cater to the people according to the advancing technology. The companies are struggling to find a way to pay for their customer’s somatic genet treatment. Among a few of the most accepted ideas in gene therapy insurance payment, transplantation of original cost according to the value can be made by rehearsing the upside and downside for the company.
Employee sponsored medical care systems might be the majority payers in the beginning according to the aforementioned model. The other widely accepted idea is to cover only the most expensive parts of the treatment which are gene editing and transplantation. This coverage’s eligibility is also tested according to the need for somatic gene therapy for the patient.
The world is changing rapidly with new technological advancements coming every day. The constantly changing world demands insurance companies to change with the advancements and thus find new ways to fund the costs of the patients.
This somatic gene therapy will revolutionize medical treatment facilities and also the way insurances function in the future. Although there is a lot of uncertainty surrounding this line of treatment, the results are promising so far.