Cell and gene therapies (CGT) are an emerging class of treatments that cure deadly conditions by modifying a patient's cellular or genetic material. CGT are typically aimed at rare conditions, with notable exceptions. As of March 2025, 44 asset-indication (i.e., therapy-disease) pairs have been approved for use in the market. With advances in Artificial Intelligence and medical research, that number is expected to swell past 60 in 2030. This creates three challenges for US-based employers who seek to pay for their employees to use these cures - high cost, uncertain durability, a large population with pre-existing conditions.
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The average therapy is priced at US$1.3m. While cell therapies are priced around US$400,000, administration costs can double the total cost to payers. Recent gene therapies are priced in the US$3m - US$5m range. Few private sector employers have enough people on their health plan to pay for such treatments affordably through traditional health insurance.
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Since many therapies are targeted at rare diseases, payers have concerns about their durability even though they have been approved by regulators. Compounding the challenge, real world evidence that might validate clinical trial results is slow to accumulate.
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Roughly 80% of those who are medically eligible for curative cell and gene therapies have a prior diagnosis that indicates their eligibility. Such patients cannot be affordably treated using traditional insurance and require alternative approaches to paying for therapy use.