Gene Therapy Explosion Forces Employer Coverage to Get Creative

Employers are grappling with the limits of both traditional and innovative payment models for coverage in trying to offer insurance for cutting-edge cell and gene therapies.

Employer coverage of the treatments is spotty at best, due to the rarity of the diseases they target and price tags that can exceed $4 million.

But their potential to alter a patient’s genetic code to cure debilitating and life-threatening diseases—particularly in children—has employers searching for ways to improve access without bankrupting the business. Strategies include paying over time, negotiating rebates based on the therapy’s effectiveness, and buying stop-loss insurance.

“I would hate ...