Recent Findings in Gene Therapy Described by Researchers from Boston University (Innovative Insurance To Improve Us Patient Access To Cell and Gene Therapy): Biotechnology – Gene Therapy

2025 FEB 06 (NewsRx) -- By a News Reporter-Staff News Editor at Gene Therapy Daily News -- Researchers detail new data in Biotechnology - Gene Therapy. According to news reporting originating in Boston, Massachusetts, by NewsRx journalists, research stated, “Policy Points Cell and gene therapies (CGTs) offer treatment for rare and oftentimes deadly disease, but their prices are high, and payers may seek to limit spending. Total annual costs of covering all existing and expected CGTs for the entire US population 2023-2035 to amount to less than $20 per person and concentrate in commercial and state Medicaid plans.”

The news reporters obtained a quote from the research from Boston University, “Reinsurance fees add to expected costs. Policies that improve coverage and affordability are needed to assure patient access to CGTs.ContextCell and gene therapies (CGTs) offer treatment to rare and oftentimes deadly diseases. Because of their high price and uncertain clinical outcomes, US insurers commonly restrain patient access to CGTs, and these barriers may create or perpetuate existing disparities. A reconsideration of existing insurance policies to improve access and reduce disparities is currently underway. One method insurers use to support access and protect them from large, unexpected claims is the purchase of reinsurance. In exchange for an upfront per-member-per-month (PMPM) premium, the reinsurer pays the claim and rebates the insurer at the end of the contract period if there are funds leftover. However, existing reinsurance plans may not cover CGTs or charge exorbitant fees for coverage.MethodsWe simulate the incremental annual per-person reinsurer costs to cover CGTs existing or expected between 2023 and 2035 for the US population and by payer type based on previously published estimates of expected US spending on CGTs, assumed US population of 330 persons, and current CGT reinsurance fees. We illustrate our methods by estimating the incremental annual per-person costs overall payers and to state Medicaid plans of sickle cell disease-targeted CGTs.FindingsWe estimate annual incremental spending on CGTs 2023-2035 to amount to $20.4 billion, or $15.69 per person. Total annual estimated spending is expected to concentrate among commercial plans. Sickle cell-targeted CGTs add a maximum of $0.78 PMPM in costs to all payers and will concentrate within state Medicaid programs. Reinsurance fees add to expected costs.ConclusionsAnnual per-person costs to provide access to CGTs are expected to concentrate in commercial and state Medicaid plans.”

According to the news reporters, the research concluded: “Policies that improve CGT coverage and affordability are needed.”

This research has been peer-reviewed.

For more information on this research see: Innovative Insurance To Improve Us Patient Access To Cell and Gene Therapy. The Milbank Quarterly, 2025. The Milbank Quarterly can be contacted at: Wiley, 111 River St, Hoboken 07030-5774, NJ, USA.

Our news correspondents report that additional information may be obtained by contacting Rena m. Conti, Boston University, Questrom Sch Business, Boston, MA, United States. Additional authors for this research include Jonathan Gruber, Andrew w. Lo, Yutong Sun, Jackie Wu and Patrick Demartino.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1111/1468-0009.12728. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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