AmeriHealth launches Advanced Network for Gene-Based Therapeutics

January 26, 2023

​As part of our comprehensive strategy for managing gene-based therapies, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, and AmeriHealth Administrators are proud to announce the establishment of our Advanced Network for Gene-Based Therapeutics.

Effective March 1, 2023, AmeriHealth will provide coverage for gene-based therapies in these best-in-class network facilities*:

These facilities are at the forefront of gene-based therapy research and development. Highly trained staff operate in accordance with protocols designed to optimize health outcomes. Together, AmeriHealth and our Advanced Network for Gene-Based Therapeutics will deliver superior patient-centered care that meets clinical, quality, and safety benchmarks.

Although gene-based therapies such as Luxturna®, Zolgensma®, and Zynteglo® can be life-changing, they also come with significant cost. Our Advanced Network for Gene-Based Therapeutics preserves patient access to these high-cost therapies while maintaining a strong focus on outcomes and value.

Coverage requirements
All gene-based therapies are eligible for coverage under the AmeriHealth medical benefit. They require precertification approval to ensure that members meet the comprehensive medical necessity criteria in our medical policies. These policies can be found on the Medical and Claim Payment Policy​ Portal.

Care management wraparound
AmeriHealth Registered Nurse Health Coaches are available to provide wraparound support to members who are candidates for gene-based therapies. This dedicated team can answer questions and help members navigate all phases of diagnosis, treatment, and follow-up care. They can also coordinate precertification reviews, help facilitate member transitions into our Advanced Network, and empower health care decision-making.

Over the next few years, gene-based therapies are expected to transform the ultra-rare and rare disease landscape. AmeriHealth will continue to ensure that we have a network of best-in-class facilities to deliver these advanced therapies and optimize member health care outcomes.

*This requirement applies to AmeriHealth New Jersey members who meet the medical necessity criteria in our policy and reside within a 40-mile radius of these hospitals. Members who meet medical necessity criteria and reside outside the 40-mile radius can receive treatment at these hospitals or at a facility closer to their residence. Some groups may have benefits that will cover a portion of travel costs associated with treatment. Individual benefits should be verified to determine if a member's plan offers these benefits.​