Gene and cell therapies offer the potential to transform the treatment pathway for patients with some of the most debilitating conditions. However, with costs routinely exceeding $1 million per treatment, these therapies can create a significant financial burden for employers.
Spark Therapeutics’ Luxturna, a therapy for vision loss, costs $425,000 per eye. Similarly, Kyowa Kirin’s Lenmeldy, a therapy for metachromatic leukodystrophy, is priced at a whopping $4.25 million.
Given these hefty price tags, it is no wonder that employers have questions about gene and cell therapies, especially as new variations enter the market. As this area gains momentum in the healthcare space, organizations should understand how gene therapies can impact their employee benefits costs. This article will highlight the potential of these gene therapies, as well as approaches employers can use to mitigate risks associated with them.
As of 2025, more than 43 gene and cell therapies have been approved by the U.S. Food and Drug Administration (FDA), according to market research firm BioInformant.
Gene therapy works by replacing a malfunctioning gene with a working copy, turning off genes that cause diseases or adding a gene to help target diseased cells, according to Healthline. It can be used to treat certain genetic conditions, such as inherited vision loss, blood disorders and spinal muscular atrophy.
Cell therapy, on the other hand, reengineers and reinfuses cells to fight disease. CAR-T cell therapy, for example, is used to treat lymphoma and multiple myeloma, according to Mass General Brigham.
These therapies have the potential to improve health outcomes significantly for patients battling conditions like sickle cell disease or leukemia. Many gene therapies are being developed as “one-and-done” treatments, helping to delay disease progression or, in some cases, cure chronic diseases.
The gene and cell therapy market is only heating up. Globally, the market for CAR T-cell therapy was valued at approximately $4.6 billion in 2024 and is projected to reach $25.1 billion by the end of 2029, according to BCC Research.
While these therapies could deliver life-changing results to members, the costs associated with them are steep. A single gene therapy treatment may cost hundreds of thousands of dollars, not including administration costs. For unprepared organizations, one claim could have a catastrophic impact on healthcare costs.
Employers should take a proactive approach to minimize the risk that these therapies can have on their healthcare spending. Here are a few considerations to keep in mind as you design your gene and cell therapy strategy.
Partner with a stop-loss provider that covers and supports gene therapies to give your organization an added layer of protection. Find out how they are approaching gene therapies from a contract standpoint.
Consider an additive carve-out solution for additional coverage. Our team partners with a dynamic solution that offers therapeutic and administrative coverage and is designed to be flexible and supportive.
Explore innovative funding models, such as outcome-based payment models, which tie provider payment to patient outcomes. This strategy can help incentivize providers to deliver high-quality, effective care.
Consult a trusted benefits advisor who can review your health plan and recommend solutions that fill in gaps in your coverage and help mitigate risk.