Cell and gene therapies have enormous potential.
They work by changing part of a patient’s genetic makeup: replacing, deleting, or inserting genes in order to treat a disease. It might sound like science fiction, but the result is very real: these treatments are already making a difference in the lives of people affected by debilitating diseases.
What Conditions Do Cellular and Gene Therapies Treat?
These interventions are typically used for diseases that are otherwise difficult or impossible to treat. The FDA has approved gene therapy products for a number of conditions, including certain types of cancers, specific inherited types of vision loss, inherited muscular dystrophy, and sickle cell disease. Read the full list of currently approved cellular and gene therapy products here.
While a few products have been approved, many more are in research and development. Clinical trials are ongoing for gene therapy treatment for severe combined immunodeficiency, leukemia, hemophilia, heart and blood vessel diseases, and infectious diseases, to name a few. Every year, more cellular and gene therapies are being developed – which is great news for many otherwise incurable diseases.
How Much Does Cell and Gene Therapy Cost?
Unfortunately, like many cutting-edge medical treatments, the cost of cell and gene therapies is astronomical.
A single dose can run anywhere from $200,000 to $3.5 million.
According to the Institute for Clinical and Economic Review (ICER), the average cost per dose is between $1 million and $2 million.
Plus, many patients require hospital stays while receiving treatment, which can add $300,000 to $700,000.
The good news is, these treatments are typically administered only once. Plus, that high, one-time cost can bring medical costs down long term if the treatment is successful. That’s because people who require this kind of medical intervention tend to be persistent high-cost claimants due to their life-altering conditions.
How Can Employers Prepare for Gene Therapy Treatment Cost?
Right now, cellular and gene therapy treatments are relatively rare.
But, as more gene therapies are developed and approved, use is bound to increase. There are a few steps employers can take to be prepared:
- Monitor drug spending through your benefits administrator.
- Request full transparency on pricing from your benefits administrator, including discount and rebate negotiations if applicable.
- Request advanced notification from your benefits administrators before new high-price therapies become available.
- Explore available stop-loss coverage focused on high-cost treatments like these but be sure you understand what conditions are covered and who is excluded.
Have questions about the best way to prepare for emerging treatments like gene therapy? CDB has the answers. Through our partnership with Emerging Therapy Solutions (ETS), employers have a strategy to manage the cost and quality of these high-cost therapies, along with access to a Center of Experience to manage cell & gene therapy requests. Together, CDB and ETS can provide employers an end-to-end program to manage cell and gene therapy costs and episodes of care for their employees and family members.