From a societal standpoint, it should go without saying that these options need to be covered in some way, shape, or form. There are no alternative treatments for many of these conditions, which can be even more expensive to maintain throughout the affected person’s lifespan.

But there’s also a long-term benefit that employers and their benefits advisors can’t ignore: some cell and gene therapies have the potential to be curative; they fix the underlying problem in a way that prescription medication or ongoing treatment can’t. Drugs are typically taken for the rest of a patient’s life or for a prolonged amount of time, but they don’t necessarily cure the disease in question.

There is a pressing need for health benefits to support employees facing exorbitant treatment costs. As prices increase, employers and their advisors must balance financial constraints with their commitment to employee health.

Strategies for managing costs 

If the cost of covering cell or gene therapy gives you pause, consider the following: At the end of the day, the price tag is really no different than catastrophic claims, which are a familiar component of risk and insurance. If an employee has a baby prematurely, for example, it could incur a million-dollar claim. That’s something you can’t plan for as a benefits leader or advisor; the best you can do is anticipate that such circumstances might arise.

It should also be noted that uptake for experimental treatments is incredibly low, which means it’s unlikely a company will be met with an influx of claims should they choose to cover them. This is due in part to the rarity of many conditions, and in part to patients’ comfort level with new therapies. An employee with a blood clotting disorder might be content to stay on their current treatment for their condition due to familiarity with how it works instead of trying a new, potentially curative gene therapy treatment.

But that doesn’t mean coverage should be out of the question. Employers and benefits advisors need to prepare for the fact that an employee may require experimental therapy down the line, the same way they prepare for potential catastrophic claims.

Here are three strategies for managing the costs of cutting-edge treatments while maintaining robust health benefits:

1. Get to know the employee population. No matter the size of the business, itlikely has a diverse employee population. They have different health backgrounds and might be dispersed across various regions.

Employers should work with their benefits advisor and third-party administrator (TPA) to collect and analyze this data. This will give them a sense of whether anyone in their population might be a potential candidate for cell or gene therapies, and they can then approach plan design accordingly.

2. Evaluate various payment models. Subscription models might be the best option for employers looking to bulk up experimental therapy coverage, as they have a very low per employee per month (PEPM) cost. A subscription model allows a business to choose from a selection of therapies to opt into, providing members with a catchall safety net of sorts. Once you’ve dug into employee data, you’ll be better informed to choose the therapies most relevant to their needs.

Subscription models do come with two important caveats, however. The business won’t be eligible if it has anyone in active membership already applying for that specific treatment. This is where knowing the population comes in handy. Additionally, subscription models will only cover the cost of the drug or therapy - not the costs associated with hospital stays or testing.

3. Prioritize and incentivize preventive care. This should be a core part of your approach to benefit design, full stop. Preventive care keeps people out of the hospital. It minimizes lost work due to personal sick days and taking care of ailing family members, ultimately providing a boost to productivity. Preventive care covers what we know works, like prescription medications, regular screenings, and vaccines.

These are all fairly low-cost with high value outcomes: When employees are encouraged to take advantage of preventive care, health issues that could develop into more serious conditions can be identified early. This reduces the need for more expensive and intensive care down the line.

Conclusion 

Cell and gene therapies are by no means a flash in the pan. Researchers at Tufts Medical Center predict the number of gene therapies approved in the U.S. will grow from 20 to 85 by 2032. And they don’t only target rare diseases; chronic conditions like diabetes could potentially be cured by stem cell therapy in our lifetimes.

Benefits leaders and advisors should thus challenge themselves to think about how these therapies are going to evolve and advance over the years. The same goes for medication. If such treatments become applicable to a wider employee base over time, then demand for coverage only stands to increase.

Until then, keep employees educated on how to take advantage of their existing benefits and incentivize them to use the high-value care that’s already available. Comprehensive health coverage is indisputably vital for employee wellbeing and organizational health alike. It’s our responsibility as employers and benefits professionals to focus on health outcomes over profit margins, especially when considering the impact of life-saving treatments.

Jim Maliekal is Director, Pharmacy Programs at Collective Health.