Gene & Cell Therapies (GCT) –The Future of Cost Containment and Risk Forecasting

One of the only constants in our industry is change. Changes ranging from small and hardly noticeable advances to massive breakthroughs in technology and medicine that will forever change our lives. Over the last two years the entire world has been given a front row seat to see why scientific and medical breakthroughs are vital to preserving humanity.  

But what does constant change mean for our industry? It means clients need to leverage the expertise and resources within companies, like Swiss Re for education, tools and resources to navigate and thrive in a rapidly advancing landscape.

We're living in a time when previously incurable diseases and illnesses will be curable with novel treatments like gene and cell therapies (GCT). GCT have already produced successful outcomes to slow the effects of diseases or outright cure them by targeting them at a genetic level. I won't try to pass myself off as a clinician, but in simple terms GCT treat diseases by inactivating, replacing or introducing genes into cells.  

The GCT field is rapidly growing, and researchers are now broadening their research treating rare diseases to more common issues such as cancer, heart disease and diabetes. For example, the FDA GCT approved list has grown from five therapies in 2022 to eighteen therapies by the end of 2022, and according to Emerging Therapy Solutions, the list of approved therapies is expected to double by 2025.    

Novel therapies come at a cost, and some GCT are personalized at an even higher cost. In addition, the research and technology used to manufacture GCT are complex and require a higher degree of quality controls and new types of manufacturing facilities.  

Physicians are educating their patients on their GCT options which involves a discussion of the risk and benefits that can be achieved through therapy, but who is educating the insurance companies?  

Speaking of risk & benefits, that is my area of expertise. As a society, we can all play a part in ensuring costs associated with medical advancements are affordable at all levels of the healthcare spectrum, so we can continue to promote innovation. Medical insurance exists and works to ensure healthcare is available and affordable by spreading the cost among a wider population.

The insurance industry is faced with the challenge of ensuring advancements in medicine continue to be accessible. This new risk needs to be appropriately underwritten and properly priced with medical care expenses managed at the provider level.  

There's a lot of uncertainty with how GCT will affect the healthcare industry and the terms frequency, utilization and severity are a few buzz words used to describe the challenge. 

There are also concerns that the reimbursement system was not built favorably for a one-time drug treatment versus the maintenance drug treatment approach, which we're all more familiar with and can easily be priced. For example, the employer stop loss market is incredibly competitive, shopped annually and these one-time cures may now be perceived as hot potatoes. A large claim payment made by a stop loss carrier in one year will help subsequent carriers due to high churn within the industry. The industry needs to develop a strategy that promotes higher persistency rates and customer loyalty. 

Swiss Re fosters a culture, that enables decision makers to stand behind our goal of making the world more resilient by developing solutions that will positively benefit our reinsurance clients.

According to recent analysis performed by Emerging Therapy Solutions (ETS), the GCT pipeline continues to grow at a rapid pace and there is now a high probability a payer with a 100,000 membership will have between three to seven GCT cases this year. 

The Swiss Re Life and Health team recognizes proper education and network alignment will be the most effective solutions for our payer partners - which is why we've partnered with industry leader, Emerging Therapy Solutions to supply educational and necessary guidance to help navigate through the ever-evolving GCT space. With access to comprehensive clinical content and forecasting, the payer can be better prepared to navigate active members seeking GCT treatment. 

In closing we should each ask ourselves, "how can I positively influence society and support medical innovation?"