Cell & Gene Therapy

Cost Management Opportunities for Cell and Gene Therapies

Costs continue to escalate at alarming rates for cell and gene therapies. Tokio Marine HCC – Stop Loss Group (TMHCC) offers a solution to manage these high cost events. TMHCC has partnered with Emerging Therapy Solutions® (ETS) for a best in class service to positively impact the plan and patient.

What is the difference between cell therapy and gene therapy? Cell therapy is defined as the transfer of live cells into a patient to lessen or cure a disease. The cells may originate from the patient or a donor. Gene therapy involves replacing a missing or mutated gene in the targeted cell to treat or cure a disease. This new gene can then help correct the missing functionality.

Another difference between cell and gene therapies is the average cost range and makeup of their typical claims. Cell therapies can cost anywhere from $700,000 to over $2,000,000, with the cost often split roughly 50/50 between therapy and general medical charges. This cost split may vary widely depending on the condition, location, and any complications that markedly increase the medical care cost component. Gene therapies, on the other hand, have a higher cost range of $950,000 to $3,300,000, with the therapy cost typically accounting for 90% of the total cost.

ETS currently offers a wide variety of cell therapy and gene therapy cost management opportunities. Click on the links below to learn more about each of the therapies. For more on these therapies, including the disease targeted, the course of treatment, the population impacted, estimated costs, and experienced network access, please contact ETS

When TMHCC stop loss policyholders use ETS for gene therapy, they will receive a 10% reduction in the specific deductible for the patient receiving gene therapy. ETS can also assist with the development of suggested plan language for incorporation of this program into the Plan Document.

The 10% step down deductible has a minimum deduction of $15,000 and a maximum of $50,000. Please see TMHCC's Best Practices in Cell & Gene Therapy for examples of how the step down deductible can save your clients' money on gene therapy treatments.

Please contact Robby Kerr at [email protected] or your regional marketing representative to learn more on how TMHCC in partnership with ETS can positively impact your clients' healthcare plans.

About Emerging Therapy Solutions

Emerging Therapy Solutions® (ETS) helps reinsurance and stop-loss payers, health plans and self-funded employers manage the risks associated with high-cost therapies for rare and complex conditions. We offer a comprehensive suite of services for solid organ and bone marrow transplants, cell and gene therapies, and other highly specialized therapies.




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