Here are a few examples of the cost and prevalence employers can expect from gene therapies. In August 2021, the FDA rejected two emerging therapies. One, for Hemophilia A, had a potential price tag between $2 and $3 million dollars. The FDA is currently re-evaluating it, with many working under the assumption that an approval will be forthcoming in 2023. This leaves many plan sponsors and stop loss carriers trying to plan for the eventual approval. Another therapy recently approved was for a very rare, inherited blood disorder. The estimated U.S. impact is 1 in 100,000 people. The treatment for this condition often results in frequent blood transfusions; that not only result in plan costs, but patient risk. The wholesale cost for this therapy is $2.8 million.8 The impact of these drugs and and the market in general • Center of excellence (CoE) therapies cannot be understated understand their risks within solutions ensure that drug for employers. Historically, most their populations, determine procurement is competitive plan sponsors have excluded how to 昀椀nance the risk, and and is administered with CoE- cellular and gene therapies provide warranty solutions negotiated rates. from coverage because they are that help provide an avenue to • Stop loss/reinsurance solutions ensure that value is delivered considered experimental and to the patient and the plan. o昀昀er step-down deductibles investigational in nature. As The following solutions vary in coordination with TPB and these therapies have improved, PBMs, where they can cover more insurers, third-party signi昀椀cantly and include their own risk. administrators (TPAs), and self- advantages and disadvantages, • And 昀椀nally, 昀椀nancing solutions funded plans are making the target markets, costs, etc., where outcomes-based and determination to cover. Plans with no solution solving for the entire risk equation for payers warranty solutions bene昀椀t may elect to cover through their or plan sponsors.8 the payers and the stop loss pharmacy bene昀椀t management carriers, but not the plan program, through capitated or 9 Here are a few solutions in brief: sponsors themselves. pooled solutions, and through • Capitation solutions will stop loss coverage now available in the market. cover speci昀椀c cell and gene therapies, with many subject Many more solutions are to pre-existing condition anticipated in the coming years exclusions and availability may to help plan sponsors, payers, be limited. 2023 Benefits Trends: The evolving workplace 68