Gene and cellular therapies are exceedingly rare – sometimes one-in-a-million rare.

They’re generally a person’s last option after doctors have exhausted all other treatment approaches to a life-threatening disease or condition.

And because of their singular, curative qualities, they’re enormously expensive, with price tags that can surpass $4 million.

“That sounds like a lot – and it is,” said Gary Petruzzelli, Vice President of Pharmacy at Capital Blue Cross. “But for some of these diseases, like hemophilia, the cost of treatment over a lifetime is millions and millions of dollars. It’s an extremely expensive upfront cost, but in addition to being lifesaving, it potentially eliminates the need for future therapy.

“These are often one-and-done, life-saving treatments,” Petruzzelli added. “The word we use a lot is ‘curative.’ Because they’re customized to each patient’s physiology and disease condition, these treatments don’t work the way regular prescriptions do. That’s one reason they’re so expensive.”

Because they’re so successful, gene and cellular therapies are likely here to stay, according to Petruzzelli. While that presents remarkable resolutions for patients, it also presents unique cost challenges for employers who want to protect vulnerable employees but wonder how they can help pay their employees’ medical bills.

The good news is that with understanding, education and preparation, businesses can do both.

Gene vs. Cell Therapies: What's the Difference?

Both gene and cellular therapies are one-of-a-kind formulations designed to target and cure individuals’ specific conditions. But they are not the same.

Gene therapy, according to the FDA, modifies a person’s genes to treat or cure disease, and can work by:

• Replacing a disease-causing gene with a healthy copy of the gene;

• Inactivating a disease-causing gene that is functioning improperly; or

• Introducing a new or modified gene into the body to help treat the disease.

Gene therapy is being studied to treat cancer, genetic diseases, infectious diseases, and more.

Cellular therapy, according to the Dana-Farber Cancer Institute, is designed to improve the immune system's ability to fight cancer. Specific cell sets are collected from the blood and modified to attack the patient’s cancer cells more vigorously. The therapy portion is when the modified cells are reinjected into the patient.

Specialists are exploring many types of cellular therapies for cancers.

The Stop Loss Solution

Employers and insurers like Capital Blue Cross are searching for innovative ways to help employees and their families access these treatments, which have the potential to change patients’ genetic codes and cure debilitating diseases.

As these lifesaving therapies evolve, so do affordable solutions for businesses and from health insurers. Strategies can include negotiating costs with the therapy’s providers based on the therapy’s success and buying stop loss insurance.

Capital Blue Cross’ family of companies now offers cell and gene therapy stop loss insurance to supplement its Administrative Services Only (ASO) group employers’ existing stop loss policies. The stop loss product covers several cell and gene treatments and places these therapies into a separate risk pool from the primary policy, thus removing the risk of premiums rising due to gene or cell therapy claims.

It’s cost-effective, too – roughly 40% to 50% the cost of similar competitor policies. Additionally, these cell and gene therapy stop loss policies are advanced funded for ASO employers with Capital Blue Cross underlying medical, meaning these businesses need not pay first and wait for reimbursement, freeing their cash flow.

“Because of their life-changing effectiveness, gene and cellular therapies are likely here to stay,” Petruzzelli said. “That’s where Capital can help. We’re proud to help employers with affordable options for coverage of these therapies.”