Unlocking the Opportunities of Cell and Gene Therapies
On November 17, 2021, Brink posted a podcast on the opportunities and challenges of the current and future state of cell and gene therapies with insights provided by Marsh McLennan Agency and Guy Carpenter experts. In the podcast, the panelists explained the concept of cell and gene therapies, and noted this is a culmination of 100 years of research. Some examples of cell and gene therapies include Yescarta and Kymriah as CAR-T cell therapies, and Luxturna and Zolgensma as current approved gene therapies on the market.
Zachary Kornblum, Pharmacy Clinical Director at Marsh McLennan explained that the opportunities for gene therapies can go beyond treating life-or-death rare diseases. He noted the potential of using these advanced therapies in chronic conditions such as Type I diabetes, where gene therapies can eliminate daily insulin injections and the risk of having extreme blood glucose levels. On the other hand, he also recognized the extremely high cost of these therapies. Currently, CAR-T therapies are the last line of defense for some cancers. These therapies come with a very high price tag some can cost half a million dollars or more. It is anticipated that cell and gene therapies will contribute roughly $25 billion to total healthcare spending.
Rick Kelly, National Practice Leader at Marsh McLennan Agency shared some insights on what employers should consider regarding coverage of cell and gene therapies. The decision to cover certain drugs can create “a selection risk” where employees may choose to work for another employer for better health coverage. For self-funded employers, he noted the importance of purchasing stop-loss insurance for their employee benefit plans. However, recognizing that the stop-loss protection does not exclude higher-cost cell and gene therapies. Thus, it is important for these employers to be fully aware of what their protection covers.
Ryan Keith, Senior Vice President at Guy Carpenter, added a perspective on two main strategies that plan sponsors can deploy to cover high cost cell and gene therapies. He notes spreading risks across multiple entities and spreading cost over a longer period of time. Coverage for cell and gene therapies can be a partnership between the public and private sector to ensure individuals receive effective therapies without dramatic financial risks to any one organization. He draws parallel from the Terrorist Risk Insurance program where there is a transparent system to share risks between the public and private entities for certain insured losses from a terrorist attack. Finally, he concluded with three main strategies for employers and plan sponsors: Prepare, Finance and Manage. Sponsors are encouraged to invest efforts into understanding the pipeline of cell and gene therapies, the implications of utilization and costs based on prevalence in their populations, as well as having sufficient education among cross-functional teams on the impact of cell and gene therapies on the employers’ health benefit coverage.
Considering the fast-paced development of cell and gene therapies, it is not too late for plan sponsors to start taking a closer look at this exciting but also challenging topic of ultra-high-cost drug management.