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We may soon have our first $1 million drug. Who will pay for it? And how?

As the first gene therapies approach the market, drug makers, insurers, and patients are debating complex questions about cost, value, and payment plans.

Gene therapy has the potential to be a one-shot treatment that could reverse blindness, restore blood-clotting function to hemophiliacs, or even cure rare diseases outright. But what kind of price tag comes with that promise — and who will pay for it?

The question is no longer academic: On Thursday, Spark Therapeutics from a Food and Drug Administration advisory panel for its gene therapy drug, Luxturna. It seems likely to win FDA approval in the coming months. But the cost will be hefty: Analysts estimate that Luxturna, which has been shown to restore vision in children with an inherited form of blindness, could cost

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