Get the most value and best outcomes from C&GT

Gene therapy aims to fix a faulty gene or replace it with a healthy gene to try to cure a disease or help the body become better at fighting a disease. Similarly, cell therapy involves the transplantation of healthy cells to replace or repair damaged ones, offering another avenue for treating various conditions. The U.S. Food and Drug Administration (FDA) has approved gene therapy products for several conditions, including cancer, spinal muscular atrophy, hemophilia and sickle cell disease.¹ C&GTs stand apart from traditional drug treatments due to their complex administration methods and high costs (reaching up to $4.25 million per therapy).² These therapies present special challenges that must be resolved to make them readily accessible and affordable for patients who need them.³ 

The 10 in-market and 12 near-term pipeline single treatment gene therapies have the potential to bring $20 per member per month cost if all 1,954 identified gene therapy candidates among our 16.5 million commercially insured members are treated.⁵ The in-market and near-term pipeline gene therapies have the maximal potential to have treated over 100 in 1M commercially insured members, or 1 per 10,000, in 2026.⁴