Cell and gene therapies are revolutionizing the medical field as life-saving treatments, but their high costs are becoming a growing concern for employers and health plans. A recent analysis revealed that more than 70% of employers and health plans anticipate that the affordability of gene therapy for their health plan members and workers will pose a significant challenge over the next 2 to 3 years. This report was presented at the Asembia ASX25 in Las Vegas by Pharmaceutical Strategies Group (PSG) and was based on feedback from over 230 health benefits executives from various organizations.
With up to a dozen new cell and gene therapies set to enter the U.S. market this year, the report highlighted the escalating prices associated with these treatments. For instance, therapies like a treatment for acute lymphoblastic leukemia can cost up to $475,000, while a treatment for hemophilia B may exceed $3 million. Despite the groundbreaking potential of these therapies, the high costs are causing apprehension among those responsible for covering the expenses.
Although these therapies offer promising outcomes, the financial implications are not well understood by many health plans and employers. The report indicated that 73% of plans foresee cell and gene therapies presenting a financial challenge in the coming years, yet nearly 40% do not currently utilize any financial protection products to manage the associated risks. Renee Rayburg, Vice President of Clinical Strategy at PSG, emphasized the need for tailored analysis considering factors like patient eligibility and treatment complexity.
Specialty drugs, including cell and gene therapies, already constitute a significant portion of prescription spending for healthcare programs. Employers are actively exploring strategies to mitigate specialty drug costs, such as adopting biosimilar versions of expensive medications like Humira. Despite costing over $50,000 per patient, plans are increasingly incorporating more affordable biosimilars of Humira in their formularies, with 65% of plans implementing a preferred drug strategy for these alternatives.
Rebekah Gregg, Chief Operating Officer at PSG, underscored the importance of adopting innovative cost-saving approaches while ensuring access to essential medications. She noted that many benefit leaders lack the necessary data and infrastructure to fully implement cost-saving strategies effectively. Transparency and data-driven insights will play a crucial role in helping organizations adapt to the financial pressures associated with specialty drugs and gene therapies.
