Take action:
Deep dive into coverage
Download a detailed checklist and review the next steps and conversation starters to help you evaluate coverage for your organization.
Download checklistThis is
Cell Therapy.
This is an innovation in disease treatment.
Navigating the integration of cell therapies into a health benefits design requires careful planning and ongoing management. By referring to these key considerations, comprehensive support can be provided to employees while trying to manage financial risk effectively.
Learn more
The potential impact
of Cell Therapies
Cell therapies are a novel approach that often helps address the root causes of disease and may be the only treatment needed to help improve a patient’s life1 and potentially prevent disease progression.2 With the right benefit structure, cell therapies have the potential to help offset costs of long-term medical interventions and treatment for your employees.1
Potential one-time
treatments1 with
acquisition costs of
$373,000 to $475,0004
Getting started:
Employer educational resources
As an employer, learning about the emerging treatment landscape and its potential impact on your organization can be key to incorporating into benefits plans.
Take action:
Conversation
1
What is the likelihood that our organization will see a claim, based on our employee population and current market availability?
2
How are therapies covered under our COC (Certificate of Coverage)?
- Does our COC include all, or only select therapies?
- Are they covered under the pharmacy benefit or the medical benefit?
- What related cost limits and requirements for out-of-pocket expenses are specified within our current policy?
3
Is there a prior authorization process within our current policy?
- What are the criteria, and who will support claim review and approval decisions?
4
How does our plan cover therapies in the case of referrals into COEs (Centers of Excellence)?
5
Does our plan cover relevant genetic testing?
6
How are we currently protecting our risk in the event of a claim?
- With these options, how much would we pay for each claim, and how can we enhance our options to better protect against financial exposure?
7
How does our stop-loss insurance cover claims?
- Does it include all or only select therapies?
- Are there specific riders or policies?
- Are there specific limitations, exclusions, lasers, or adjusted cost sharing we should be aware of?
8
Are we eligible to enroll in other programmatic offerings from national plan carriers or third parties?
- What services do they provide, and what are the associated costs and benefits?
Understanding the benefits and challenges of cell therapy
In the dynamic world of healthcare advancements, understanding the impact of emerging treatments is essential for making informed decisions about employee health benefits.
Emerging therapies have the potential to help address the root causes of disease and may only require a one-time administration.1 For many patients, these therapies could mean fewer hospital visits, reduced need for ongoing treatments, and in some cases, a potential cure.1,7,8 When administered early enough, they may potentially prevent disease progression.2
Managing therapy costs
The unique nature of therapies and their complex manufacturing processes contribute to the high cost per treatment.9 For employers considering incorporating them into health benefits plans, understanding these costs is essential. The high initial investment should be evaluated against providing potential long-term savings and improved patient outcomes, which may benefit both employees and employers.1
References
References
01
Salzman R, et al. Addressing the value of
gene therapy and enhancing patient
access to transformative treatments. Mol
Ther. 2018;26:2717-2726. https://
doi.org/10.1016/j.ymthe.2018.10.017
02
Gene Therapy Approaches. American
Society for Cell and Gene Therapy.
Accessed February 6, 2026.
https://patienteducation.asgct.org/gene-
therapy-101/gene-therapy-approaches
03
National Cancer Institute. T-Cell Transfer
Therapy. Updated: February 26, 2025.
https://www.cancer.gov/about-cancer/
treatment/types/immunotherapy/t-cell-
transfer-therapy
04
Yan-Ruide Li, Yichen Zhu, Ying Fang, Zibai
Lyu, Lili Yang. Emerging trends in clinical
allogeneic CAR cell therapy. Med. Volume
6, Issue 8, 2025, 100677, ISSN
2666-6340. https://doi.org/10.1016/
j.medj.2025.100677
05
Lopata E, Terrone C, Gopalan A.
Opportunities and challenges surrounding financial models for high-investment medications: A survey of access decision-makers and employers. J Manag Care Spec Pharm. 2023 Jul;29(7):782-790. doi: 10.18553/jmcp.2023.22436. Epub 2023 May 3. PMID: 37133434; PMCID:
PMC10388234. https://
pubmed.ncbi.nlm.nih.gov/37133434/
06
Rouce RH, Porteus MH. Cell and gene
therapy accessibility. Science.
385,475-475(2024). doi:10.1126/
science.ads025. https://www.science.org/
doi/10.1126/science.ads0252#tab-
citations
07
Melenhorst JJ, et al. Decade-long
leukaemia remissions with persistence of
CD4+ CAR T cells. Nature.
2022;602:503-509. https://
doi.org/10.1038/s41586-021-04390-6
08
Johnson PC, et al. Longitudinal
patient-reported outcomes in patients
receiving chimeric antigen receptor T-cell
therapy. Blood Adv.
7, 2023;7:3541-3550.
09
Apex Benefits. Benefits insight: cell and
gene therapy cost management. May 24,
2023. Accessed February 6, 2026.
https://apexbg.com/gene-therapy-cost-
management/