We’ve all seen the headlines: gene therapies are revolutionizing medicine and carrying million-dollar price tags. And while yes, they can be extremely expensive, the reality is the actual use of these therapies is still relatively rare.
Cell therapy, however, is having a much larger and lasting impact on health care costs, quietly and steadily reshaping the landscape. According to the IQVIA Institute, global spending on cell therapies has reached nearly $5 billion—about twice the spend as gene therapies, which had leveled off at around $1.5 billion in 2021-2023 before climbing again to $2.5 billion in 2024.
What’s behind this growth? Chimeric antigen receptor T-cell therapy, commonly known as CAR-T cell therapies. These personalized cancer treatments show remarkable promise but require a lot of specialized care. Costs can add up quickly, not only for the therapy itself, but also for the experienced teams, hospital stays and ongoing monitoring required to support patients.
What this means for self-funded groups
Cell therapy is now one of the fastest-growing and most unpredictable sources of risk for self-funded groups. Whether you manage a self-funded plan or advise those who do, it’s critical to understand what’s driving these high-cost claims. A closer look reveals several contributing factors:
- Cancer remains the main driver of high-cost claims.
- CAR-T therapies are being used more often and not just as a last option, but earlier in some cancer treatment plans.
- More claims are exceeding the million-dollar mark, increasing volatility.
Together, these factors make cell therapy a growing concern that requires close monitoring and proactive planning.
The value of the right stop loss partner
With today’s treatment landscape, financial protection alone isn’t enough. Self-funded groups need a stop loss carrier with experience, clinical insight and operational strength to help manage these high-cost, complex cases.
Here’s what to look for when considering a stop loss carrier:
- Responsive claims support, backed by experienced clinical teams.
- Expedited reimbursements for ASO claims to protect the group’s cash flow.
- Proactive cost-containment strategies for high-dollar treatments.
- Transparent contracts with no hidden exclusions.
- Rate caps with no new lasers, offering long-term budget predictability.
The bottom line
Gene therapies might get the most attention, but it’s cell therapies—particularly CAR-T— that are quietly driving up health care costs. As these treatments become more common, it’s important to be prepared for their financial impact.
The good news? With the right stop loss partner in place, groups can navigate these challenges with confidence. Expert clinical guidance, strong claims support, clear coverage and financial protection all work together to provide stability when it’s needed most.
Protecting people and budgets from the impact of next-generation therapies isn’t just about having stop loss protection, it’s about having the right partner by your side.
