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Cell and gene therapy still rare for plans, barriers begin to fade

Lockton estimates annual incidence of gene therapy at 6.3 per million lives and cell therapy at 15 per million lives among its clients.

Reported · Written up by our desk · Health Insurance

Cell and gene therapy price tags can run between $2 million and $4 million per treatment, but employer exposure via health benefit plans has stayed limited, according to an analysis from Lockton.

Lockton’s SAGE Intelligence Platform data shows gene therapy cases at 6.25 per million lives annually among its clients and cell therapy cases at 15 per million lives, rates that have not translated into broad, plan-level cost pressure.

The brokerage attributes the limited burden to operational and clinical barriers that prevent eligible patients from reaching treatment, including a small number of qualified treatment centers, strict clinical eligibility and prior authorization, and complex manufacturing and scheduling timelines.

Lockton says access is further constrained by the concentration of care delivery in major health systems, along with prolonged post-treatment monitoring, requirements for patients to remain near specialized centers, and the need for significant caregiver support. It characterizes the current situation as a temporary reprieve rather than a permanent baseline.

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