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Gene-Based, Cellular and Other Innovative Therapies
Explore quality coverage with end-to-end support to help members most in need.
Seamless care and supportAnd protection for your bottom line
These therapies have the potential to treat, or even cure, once untreatable conditions. The right coverage matters.
Our Gene-Based, Cellular and Other Innovative Therapies (GCIT®) program offers an integrated approach to the access, coordination and cost management of these lifesaving therapies. We’re here for members from the moment they learn they need therapy. We help them navigate their benefits and offer guidance during treatment and beyond.
Governance and oversight
We anticipate pipeline therapies and evaluate coverage for these therapies using forecasting tools for risk assessment.
Dedicated clinical team
We support members throughout their journey, from precertification to aftercare, by a team with expertise in GCIT therapies.
Designated national network
We guide members to treatment centers vetted for quality and cost efficiency to help manage the high cost of these therapies.
GCIT defined benefit
We encourage use of the GCIT-designated network through flexible plan designs and a unique drug cost share.
Specialty pharmacy
Our partnership with CVS Specialty Pharmacy opens up additional access points to members through care coordination, dispensing and specialty pharmacies.
For self-insured plan sponsors
Protecting you from high-cost claims
Only a small number of members may need to use a GCIT facility. But if they do, we've got them covered. We've got you covered, too.
Stop loss helps protect you from losses by providing coverage for large dollar claims. You only need to meet a deductible. We cover a wide range of therapies when members receive therapy at a GCIT-designated treatment center. It’s like a safety net to protect your bottom line.
Questions about stop loss and GCIT coverage?
Get in touch with us. We’re here to help.
Benefits you can count on
More than a network solution
More than a network solution
Ensuring members have the expertise and support to have the best experience and outcome possible. It’s one way healthier happens together®.
- No added cost: Your Aetna medical plan includes customizable pricing as a standard benefit. There’s no additional upfront cost to you.
- Integrated value: As part of CVS Heath®, we’re able to combine our strengths. Together, we offer a continuum of support, care management and cost management.
- Seamless experience: You get one carrier for medical and gene therapy coverage. That means aligned networks, simplified claims, better care coordination and less member disruption.
- Network discounts: We negotiate discounts across our GCIT provider network to help you manage the high costs of these therapies.
- More therapies: Members get access to a wider array of therapies with over 200 facilities nationwide and growing.
Putting members first
Putting members first
Being diagnosed with a condition that needs gene or cellular therapy can be scary. We’re helping to ease some of the worry for members by knowing quality, choice and value are already built into their care journey.
- Travel and lodging reimbursement: If members need to travel for care, they can do so with peace of mind and without a cost burden.
- Quality care without the markup: Providers in the national GCIT network are vetted for quality and agree to special rates.
- Help navigating claims and approvals: We work with providers to manage claims and approvals so members can focus on health and healing.
- Clinical support for complex needs: A physician-led team with GCIT expertise provides care management and support throughout treatment.
- More facilities for more convenience: We specially choose facilities that meet specific therapy handling requirements and cost standards.
Legal notices
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company, Aetna Health Inc. and Aetna Better Health of Washington (Aetna) and their affiliates. Aetna® is part of the CVS Health® family of companies.
CVS Specialty® and the Specialty Pharmacy Network may not be available to California HMO members. Doctors may have agreed to dispense and administer these drugs to members themselves. Or they may write a prescription so that members can fill them at any participating retail or mail-service pharmacy.
Health benefits and health insurance plans contain exclusions and limitations.