Breakthrough to Bottom Line: Reinsurance Trends in Gene & Cell Therapy Claims

Gene and cell therapies are revolutionizing the healthcare landscape, offering transformative outcomes for patients. As these therapies move from niche applications into broader clinical use, they are also reshaping the financial dynamics for payers and reinsurers.

In our latest report, US Health claims data show a rise in utilization and cost exposure, highlighting the need for proactive risk management strategies.

Therapy uptake and financial impact

The past several years have seen significant growth in gene and cell therapy approvals, label expansions, and overall acceptance and availability to receive treatment. This shift has led to a surge in claims activity, with four key diagnoses driving the trend:

• Diffuse Large B-Cell Lymphoma (DLBCL) – Yescarta, Kymriah, Breyanzi
• Multiple Myeloma (MM) – Abecma, Carvykti
• Spinal Muscular Atrophy (SMA) – Zolgensma
• Duchenne Muscular Dystrophy (DMD) – Elevidys

CAR-T therapies

CAR-T therapies account for about 80% of gene and cell therapy claims. Most claims originate from Commercial and Medicare populations, with Medicaid representing a smaller share. Costs vary significantly by payer type:

• Claims range from $500K to over $1M.
• Average claims are higher in commercial populations, with a larger range of costs.

CAR-T and traditional cancer treatments

CAR-T therapies are increasingly being used for certain blood cancers and treating advanced or relapsed and refractory cancers as 2^nd or 3^rd line treatments. Across all payer types, CAR-T therapies are contributing to a rising share of total cancer spend, outpacing many traditional treatment modalities.

The shift toward outpatient administration

CAR-T therapies are becoming more accessible through outpatient utilization, allowing for more patients to be treated and for wider access in community and regional medical centers. Continued monitoring is needed to determine long-term cost implications of this trend.

Managing risk in a rapidly evolving market

Gene and cell therapies are no longer confined to rare diseases. As their application expands into larger patient populations, the financial exposure for payers and reinsurers grows. PartnerRe’s PULSE+Plus® team offers solutions to help clients navigate this evolving environment, including:

• FDA pipeline monitoring for new approvals and expanded indications.
• Contracting strategies to mitigate high markups, especially for out-of-network treatments.
• Access to top therapy networks.
• Detailed claims insights to support proactive underwriting and risk management.

With a data-driven approach and strategic mindset, PartnerRe empowers clients and brokers to anticipate emerging risks and make informed decisions in a fast-changing therapeutic landscape.

Access our recent gene and cell therapy report to learn more.

Contributors

Benjamin Dahlman, Actuarial Analyst, US Health

Crystal Kauder, Chief Actuary, US Health

Tina Anderson, AVP, Clinical Services, PULSE + Plus ®, US Health

 

This article is for general information, education, and discussion purposes only. It does not constitute legal, medical or professional advice and does not necessarily reflect, in whole or in part, any corporate position, opinion or view of PartnerRe or its affiliates.