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Drug costs

Cell and gene therapies

Life-saving and industry-changing, cell and gene therapies are rewriting the calculus for healthcare payers and providers, pharmaceutical manufacturers and patients.

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Overview

New medicine requires new math

For people with rare conditions, cell and gene therapies (CGTs) represent a medical breakthrough. These novel treatments modify or replace a patient’s cells or genes to attack diseases including hemophilia B and sickle cell. 

But CGTs come with high costs, creating challenges—and opportunities—across the healthcare ecosystem. Milliman research explores how state Medicaid agencies, commercial insurers, and other stakeholders can respond.

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CRITICAL POINT PODCAST

How will Medicaid pay for cell and gene therapies?

We review the strategies states are using to mitigate risk, predict uptake, and control costs.

Listen to our podcast on the topic, and read the accompanying article.

Insight

Read more CGT insights

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White paper

CMS Cell and Gene Therapy Access Model

A look at the model’s benefits, limitations, and considerations for expansion.

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White paper

Exploring the provider landscape in sickle cell disease through a gene therapy lens

What the CMS model will mean for patient access to breakthrough, high-cost treatment for sickle cell disease.

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White paper

CGTs: Informing the uncertainties using research and retrospective claims analysis

Leveraging clinical research, market monitoring, and claims analysis to estimate cost exposure.

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REPORT

Complexities in forecasting eligible cases and associated costs of cell and gene therapy

Exploring the CGT pipeline, approvals, treatment rate, and more. 

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Article

The uncertainties and benefits of gene and cell therapies: A payer's dilemma

Gene therapies, CAR T-cell therapies, and other innovative (and potentially curative) therapies are beginning to enter the market, and are making waves with their record-setting prices.

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Article

The future is now: Are payers ready for gene therapies?

Gene therapies for rare diseases may offer a life-changing treatment option for some patients, but can payers keep up with the cost?

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The access challenges facing healthcare products are becoming more and more complex. With direct experience serving stakeholders across the U.S. healthcare system, we can help you understand the market, identify actionable insights, develop market-ready strategies, and execute to the top of your potential.

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Regulatory complexity makes Medicaid a challenging market for all concerned—governments, providers, and plans alike. Milliman's experts have diverse actuarial, operational, and market experience from decades in the realm of government healthcare services.

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