Cell and gene therapies (CGTs) are a relatively new frontier in medicine, offering the potential to treat or potentially cure rare diseases by targeting their root causes at the cellular or genetic level. These therapies can dramatically improve a patient’s quality of life, but they come with extremely high costs. While only a limited number of CGTs are approved, their use is growing, and more therapies are in the pipeline. As a result, the financial implications for employers and employment-based health plans are likely to increase over time.
In this Issue Brief, we use claims data to examine the evolving landscape of CGTs within employment-based health plans. We analyze the prevalence of conditions targeted by CGTs, patterns in therapy utilization, and the broader spending implications for enrollees who use these therapies. Our analysis further highlights the disproportionate concentration of CGT-related costs among a small subset of high-cost claimants and explores emerging strategies that employers and insurers may consider to manage the associated financial risks.
Key Findings:
- Rising Number of Approvals: As of 2025, the U.S. Food and Drug Administration (FDA) has approved 48 CGTs, with more in development. A growing number of these therapies are targeting conditions that are more common than traditional rare diseases.
- Modest Growth in Use: Use of CGTs remains limited but has shown a gradual increase. In 2018, 7.9 per 100,000 enrollees received a CGT; by 2022, the rate rose to 9.2 per 100,000.
- Small Share of Spending: CGT users represent fewer than one-tenth of one percent of the enrollee population but account for approximately one-half of one percent of total spending. This includes both the cost of CGTs and spending on other health services. These proportions have remained relatively stable between 2018 and 2022.
- Impact on High-Cost Claimants: Among enrollees in the top 1 percent of total health care spenders, just 0.58 percent used CGTs. However, these individuals accounted for 1.6 percent of spending within that top-spending group. While the share is small, it signals that CGTs can meaningfully impact spending patterns among high-cost claimants.
As CGTs evolve from rare to more common disease applications, their financial footprint within employment-based health plans is likely to grow. Employers are beginning to explore innovative solutions to manage these costs, including stop-loss insurance, carve-out programs, gene therapy reinsurance, value-based payment arrangements, and performance-based contracts.
Understanding the trajectory and implications of CGTs is critical for employers, policymakers, and health plan sponsors. While current utilization and spending remain limited, the pipeline of therapies and their high costs warrant close attention to ensure sustainable access and benefit design in the years ahead.
This study was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI CRHBI), with the funding support of the following organizations: Aon, Blue Cross Blue Shield Association, Johnson & Johnson, JP Morgan Chase, and PhRMA.
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C rlie reie rc r, G la h d T ia is m -s d re e s d a la ses eta v ete d alop t .rspe e Ae a s a d tnding e d ar e c bsu la y iinc lC m t, G s his lude c Ts er ta a ts not r o in ind er yv e w ronly it y ivh idu spe t he ta he cls ifi e c c m c ost la a ps nd loy si of fied e ra rtr .h e e Ia . n a s non tW he d he rdait n a - pus ion, y, e ne b rs ut si w nc m a C a leso e G y C T in fa G is xpe T s ac p a tns p rh e re a ov s ve e d with the funding support of the following organizations: Aon, Blue Cross Blue Shield Association, Johnson & To To Ande m illus r ason, G nta ra gtee he e how ra arltd h b a F., si engle ne Uw fit e s c high E. ost Re -cs, m inh osta c a rla d ny ti, m e P am e ntp te lo r c a y S. n a erH s h fus fea sey, cv t ee m aa dp nd op loy tVa e ed rrs d d high uhi iffe -P d re e et nt d ros uc ly y tb ible aa n. sed 20 he on 03 alt. h p the "Itla ir ’s The ns si ze (H , D P cr H on ic Pe si ss, St )d. eA r s of upid the 20 foll : W 25 ow h,y ing Fi Em gur ploy e 1, ers t Dis hta rt ibut self ion o -insu f He re ta hle th Sp ir hee anding lth pla , n Asm oft ong en p Indivi urcha dua se lsst W op ith -loss Em p ins loy um rae nc nt e- B to ased pro tH ee cta lt the h C m ov selves erag ef, rom 2022 ............ 4 Insu 50rance: Financing the High-Cost, High-Impact Future Prevalence of Select Conditions Treated With CGTs a int r inc e nd ce ur ende iv b re e ec d d d om d a aur s one C eing s a GT.v p -atril im ea-b e dle ia t, rg etnosi a he tm re s e , nt is a s, t d am su he ini rg s se ter a c in usa tla ion, ims a a gnd er e d p ue oft ost e to n -tr a not e p at ool m consi eof nt d p m e aoni rte iednt t or as w s p ing. a air tG ting iv of efor a n th n e te rm e sc a ptloy a m le e e n r a'tnd s c . Hlp a ow a im ce e s his v e of r,C ta o G s rT yt he at se the e Hxa DH m Pp s m Johns le. The us In 2023 ton, Unit hav JP e e , d d t Mor he e St d a uc g ata v ete n C s ible rI as So g h s t e a se, ha annu D tiff a a nd e a re r l p e P no nt r hRMA e m Fr leiu ss om m . t ha Ot for n $ he erm 1, C p 6oun l5 oy 0 for e tr eie - only s." emp H c loy eov alt e eh e ra -A only gff ea a ir m c sov ong 22 e r(a 3) e gm e : p 89 aloy nd -1 e$3 05 rs w ,.3 00 ith 1,000 for fam or ily m cov ore e rage. unexpectedly large claims. Stop-loss coverage reimburses the employer for claims that exceed predetermined Wagner, Tyler D., Brian Sils, and Jonathan D. Campbell. 2025. Cell and Gene Therapy: Patient and Caregiver Odyssey. February 1 Figur 2e , 2, 20C2 um 6 ula • N tivo e. N 651 umbe r of Cell and Gene Therapy Approvals, 2010–2024 .......................................................... 5 1 By Paul Fronstin, Ph.D., and Keshob Sharma, Ph.D., Employee Benefit Research Institute d d tim e isv e e e a lop of ses 45 r m eae ne rnt ew r(a aW r l.e ong , onc ee t a the l., 2 e02 xis3) ting , trp aool ditiona of indiv l meidua thodls s of get m ta re na atgeing d, the hea a ltn h nua carl enu cost mbse — r of su pcah a tient s d s erd euc cetiv ible ing s, the 43 C W em G itTs p h th loy are eee ir s us gw reow a ds a for ing p p tp he roxi re v tm raele a atn te m cly e e ,nt $8 H D ,300 of Ha P s .fe ha w For vre a a rb n e ee c cond om mpe loy it ions ae foc r w . a The itl p h 1,000 oint num in d b ceov ris of c eu re ss pd aion te ie m s a nt ps in t loy roun eeh d se , etUnit m otp aloy l he ede St a r ltc ah c ost tesa - r for sh e a spe so ring m nding e of thresholds. Importantly, stop-loss insurance is not medical coverage and does not provide any direct protection or 3. Inabil Nit ay tion toa A l P nha aly rm ze In aceut diiv caid l C uou al T nch il. A era cc pe ies sse :d B Ma ecarus ch 3, e of 2t02 he5 . lim htit tp ed s:/ num /wwbw e.np r of cnow CGT use .org/r rs id esour entcifi es/ ed c,e we ll-and did -gn eot ne - Belousova, Alina, Eddie Albers, Benjamin Ryzmo, Andrew Peel, and Ben Paik. 2025. The Rise of Cell and Gene t crop eaa tm ym ee nnt t m s, aa ynd dec coins rease. ura nce — may no longer be sufficient to address the financial challenges CGTs pose. Paul Fronstin is director of Health Benefits Research at the Employee Benefit Research Institute (EBRI). Keshob w stould rateg a ie m s. How ount te o va eb r, out em $8 ploy .3 mi ers us llion e. aFo va r ra ie n e ty m ofp c loy ose t- rsh wa itrh ing 10m 0,00 echa 0 e ninr sm olle s b ee sy , ond that d figu educ ret ible would s to sc inaflu le e to nc$8 e e 30 m p m loy illion ee . t Fi he gur se er a 3, reP r ce ond vale ition nces is of Se ver le yc sm t Cond all, w ition hics, p h me era ns 10 0,00 that0 En even in rollea e s Wi data th Em set of p13 loy m to e1 nt 9 mi -Based llion e He nr aolle lth C eov s, e wre a gae r e ................. dealing 7 benefits to workers. 40 Som conde uc st t op c the os -loss r ta a pny a c-a ly pra se rtie ie s rn s att- a a ls the nd o -offe le ca vre e rl o g st iv f aend indiv r-od -alone idua ysse l y ct.o he verraapgie es op . tions that provide protection for specific high-cost services, Therapies. Marsh & McLennan Companies, Inc. Available at https://www.mercer.com/assets/us/en_us/shared- Sharma is a health research associate at EBRI. This Issue Brief was written with assistance from the Institute’s w be itha h sm vior a ll sa and m m pale n asi gze e s spe . Fu nding rther. m These ore, so inc mlude e CG c Ts op ha ayv m ee s np ts, c ecifioin c rsu eqruir ane cm e,e tnt ies re fo d rc t ost rea s tm tru ec nt tu lik res for e rela p prsed ovide orr sr e afr nd ac tory Figure 4, Number of Cell and Gene Therapy Users, per 100,000 Enrollees, 2018–2022 ............................................... 8 Ult I su nt cim h a rao tse duc C lyG , T the st. ion These app rov paolic l and ies atd yp op icta ion o lly do f C not GTs us w eill la fo sers rceFigure apnd aye m rs a 4 y — offe parrt ia c ul maorrly e e am pp prloy opr eia rst e— solu to trion for eevalua ctov e how erag e the y Cell and Gene Therapies in Employment-Based Health Now, assa um sse et s/ a lo high cal/a -co ttst ac c hla mie m nt an s/pd t —f -su usc-h 2025 as a -n e thenr -rio se lle -of e -rc ee cll e-iv and ing -g ae C ne G-T the —r a inc pie us rs -sep $1 am raill ting ion -s in he ignaa l-lfr th c om a-rnois e cos e-tV3 s. .pdf. Unlikre e sea ther c st h a eand dy in edcit re or aia se l st ina tff he s. p Ae ny rc e vnt iew ag s e e of xpreem ss pe loy d in t ers his who rep self ort- ins are ur te hose d as of firm the si a ze ut g hor rew a, nd the sh pould reva le not nc e b eof asc stop ribe - d prescription drugs, value-based insurance design, and reference pricing. multiple myeloma, which can be challenging to identify in the data. Despite the challenges, we have identified enrollees 35 33 W These ong, lim Chi Hee itation m s unde , Dexin rs c Lor i, e N ina the W cha ang, llenge Jona s of thast n G udryube ing rr, aA re ndrew , high -W cos . Lto, intaend rveRe ntna ion s i M. n a Cont dm i. ini 20 st23 rat. iv "The e datEast aim nd ated t fin rea an tm cee n he ts lik alth c e C aG reT . sA . s m They ore m p aa yt ie be nt Nu m s b or m eec be om apr p eof e e aligib lin Cell an g le to ala nd rd ge m G or een m ep e tloy he Th r ea rp erapy s w ies e ho nt d Users, e o r ptur hec h m aa se rke sttop , e-m loss ploy . ers will need to One Based of on the t he cr uc prie av l s ale tanc tise tic rs in ate of he9. alt2 h C cG ar T e us is etrhe s p 80 er /2 10 0 r 0,ul 00 e0 — indiv app idua roxim ls a wtie th a ly 20 ra p re e rc con ent d it of ion the (Fi p gop urula e 4) tion , the ac la coun rge t for loss coverage among self-insured employers did not follow a similar pattern, instead varying significantly by firm size. Ins Figur te o u 5, the rSp a offic en nding c ere s, t : on rus F H te ein e as, or lta h Cn a orc te he in Se r r sponsor vg ic th es, bs of ye Use Hi EB of RIg , GEh em ne -pCo loy Ther ees a B pt y e, , ne AHigh fit m ong Resea Top - rcI h I Sp mp ns ende tita ut rs, 202 c e-Etd Fu uc 2a ............................. tion a tund re Re search 8 with rare diseases and can determine the prevalence of a number of conditions, such as sickle cell disease, spinal highlight Atnnu he ne al Fina ed for nc im ial I prm ov pe ad c tc of oding Gene pr a Thera ctices a py nd in te he xpa Unit nde ed d a St cc ae te ss s." to Gceom ne pThera rehens py iv 30 e d : a76 tasets 1-773. . Belousova, Alina, Raymond Brown, and per Andrew 100,000 Peel. EEnrollees, mployers’ top 2018 four – q2022 uestions about cell and gene therapies. adopt new financing strategies to ensure the sustainability of health benefits. D 80 em e d p puc loy ertcible e 30 ernt w s a of ith 100,0 rtehe ty spe pic00 anding lly e nr mu oll . c Th h low eees w ste a ould rt is tha tic b n a ep t e he pxp lie $6 e sc t ,0 to e00 dt he t o or p ha op mvor e ula e a tb in ion out annu w nine ith al sp e su mp c eh hig lo nd ying me hnt -see c- ost bn a sed a cla miong m he aa n lt tthe s h b ( Fi 20 eg ne uprfit e er s c 8) e a. n s w t The of ell. to For tal In 2024 Fund , e(m EB pRI loy-e Ee RF) s in fi , orr m the s w ir it st h 100 affs. N –9 e99 ithe erm EpB loy RIe no es w r Ee BrRI e m -Eost RF lob likebly ie ts or o b et ain p kes p lans osit w ions ith st on opspe -loss cifi ccov pe olic rag ye p (r93 op osals. muscular atrophy, and hemophilia, from the data. Among individuals with employment-based he 27alth coverage in 2022, 10 Figure 6, Percentage of Private-Sector Establishments Offering Health Plans That Self-Insure at Least One Plan, by Firm By Oth Pa er ul Fro Fi 20 nanc 25. ns Me ing trin, P c e Op r. A th.D. iv on aila sb , fle or a nd a t Emp ht Ke tplo s:/ shob y/ww ers Shar w .merma cer.c , oPh.D. m/en-u , s/ Emp insigh loye ts/ue s- Ben health e-fi ne t R ws/ ee sm ea ploy rch I ers-ns top titut -foure- e c indiv ost xam idua of ple the ,l s w in 202 se ho cla 2 a im ,c c 20 s w ount p ould e rfo ce rrn e atp p of rpersent oxim the pr aop oug teula lyhly 80 tion 1 p.1 ear c c pc e e ount n rc t eof nt ed t of ot for atl he he 84 e a m p lte h c prloy ce ant reer ’of c s oov st the s e.r a tMo o ll the a re l ov a spe lte h c nding r, a out re - spe ( of Fi-g p nding ur oce k e 1) t . . B m A ya vxim ceont rau grm e a ss t, — percent). Coverage rates were lower in both directions on the firm-size scale: 70 percent for firms with 25–99 EBRI invites comment on this research. the prevalence of sickle cell disease was 23.7 per 100,000 enrollees, spinal muscular atrophy had 2 cases per 100,000 25 Size, 2024 ............................................................................................................................................... 9 questions-about-cell-and-gene-therapies. 22 A spe t w he n im hic nding sm h e pa or nc lle tin t a om rn etm his pca on pss loy gsi ra oup d ell for e r rw a w titm ion h 1, as s o $ w 00 30 f c he 0 e ,000 ost n e m s v, ha p atloy lua ho ring e t ugh ing e s w —m st a ould op e re d - ia rloss e n sp bla e t e iv ce xp ov e nly d e e ing c rins a te gd ignifi e w tis a o s $15 tha c ha av n te t,000 i tin t 0.09 typ he . i2 H c a igh su cllon yc h e a t ue p ser xt pnr lie s of olle s t — tot o e oft sa a l sp — ll en r he le ee a nding ss fe lt h c r tha rea d n o for r e to ne chigh os as high . tFor s -co tst -he c ost 9 employees, 71 percent for firms with 1,000 or more employees, 52 percent for firm 9.4s with 10–24 employees, and 29 enrollees, hemophilia A was 10.9 per 100,000 enrollees, and hemophilia B was 2.4 per 100,000 enrollees in the data Conclusion 9.2 Data and Study Sample p c us la ur e im p rs, p Su ose ang ta s of s, t g rtes ic he ula tted his crost l Ci y ill u tltatio hose ie stst ra tpion, n raet :c ie Fr ent w iv ons e s, or t ing round t in, P CG op T a s. up ul, spe Aa s a a nde nd nd ra e rK ss s in t su eum sh lt, ob he e d e t Sha he d huc e a sm rtlt m ible h sy a alle ,s “ st r a C nd e e em ll a mot p — nd loy he a e G rr re e c ha os ne com ts one -Ther sh m aonl r a in high py g ie indiv m s i -e cn Em ost cha idua nis cp lalloy s w im msm a it n of e h signifi tnt t . eTha -n Bha ased t v $1 ce a nt H lim te ,t il le alion lt th o incurred by an enrollee, not just the cost of the CGT. While stop-loss policies receive significant attention — largely p Fie grur cee nt 7, for Am fiong rms w Seitlfh fe -Ins w ur ee r d tha Pla n 1 ns0 e , Pe m rp ce loy nte of es. The Privat e low -Se c cov tore rW ag or ek rearts E es nr am olle ong d in a the P sm laa n Wit llest h Stop firms m -La os y s C reflect over a a gla ec , k b y of 20 18 (Figure 3). 8.6 The Bragg ar , ow Luiing za A us m ea of ra C Ma GTs cie l, prC ea sent rlos G s bilbe oth a rt C tron A ans teT fo Fi r lho, ma A tiv ® a e nd op G Fa pL or bio tA uni BaN ttyis in m tC a Mo E ed ta ic . a20 l tr 2e 2. " atm Fu ent tur a end of a g e fin ne atn ic c ia the l crha aplle ies for nge for 17 8 8.4 For this study, we analyzed data from the MarketScan Commercial Database covering the years 2018 to 2022. The 16 no b c int la ec e ie m a ns I ff us ns e w ive cur ould e t ,ta on he anc nd yrhow e ea : p crom Fi r ee na tsent ahe p lrnc le ese a x me ing d 12 indiv y w p the d e e ic r ill d ca - H e ua e l ne igh nt st ls aof e -b us C d lis ost ts. The e ot h he e a , d l sp H a a igh lt se nd h ca ending -indiv Ifa m rm e p a idua ili serv .c a t rFu ltis us c oo teur s. lse ua E for ,” m lly E p la B r loy e RI rg qe e uir Ir rss s e eue see m ong p B loy kr ing oing ie efr, s to no. or — m in ot a 65 n th e a 1e ns g r(e E iv fin m te he a pc n loy a fin cring e ea e for nc m Bia e e cne l i hr ch m on fit ap nis ic a Re c m tsea s a of rrc eh EndnotFi ers m Size, 2024 ..................................................................................................................................... 10 awareness of their stop-loss arrangements, confusion abo15 ut the terminology, and the affordability and volatility of the rare genetic diseases: what to expect for the next 15 years?" Therapeutic Advances in Rare Disease. employment-based he 7.9alth plans. These therapies offer the potential for life-altering or even curative outcomes, database includes detailed enrollment records along with inpatient, outpatient, and pharmacy claims for policyholders 15 C c eond nr ell a olle Iit ns nd ion ets r it g s. u ee tne e D c, e e iv Fe fin the ing b itrrions a ua C pG ie ry T s (C fo s 12 rw , high G ill 20 T ne s26 )- c e aost )d r.e t o a c la e re xplore im laa tiv ntes t ly a lt y ne e pric w na a lly fr tiv on e re ts liy e tr ra on in m teg aie nnu es b dic ae ine l he yond , aoffe lt h ca tra ring dr iteion tspe he a l c nding pot ost ent - sh tia hr a l to tr r eing shold m eaod s or t or els p p .e ot rc ee nn tt ia ile lly - e merging that specifically target the unique financial chFi allgu enge re p 3osed by CGTs. stop-loss premium. At the other end, large firms m 12 ay forgo stop-loss because they can spread the cost of high claims 7 particular dloi:10.1 y for indi 17v7/ idua 2633 ls w 004 ith r 02a 21 re10 cond 0840 itions . . However, their substantial price tags — combined with additional costs Figure 8, Illustrated Impact of High-Cost Claimants, by Employer Size ....................................................................... 9 If both employers were to experience one additional $1 million claimant, the smaller employer would now have two and their spouses and dependents. We limited our analysis to individuals under age 65 who maintained continuous cure rare diseases by targeting their root causes at the cellular or genetic level. These therapies can dramatically based cutoffs, but it caPrev n be aalen greed ce tha of t a Select small se Co gm nd eniti t of on the s, p pe opr 100,000 ulation usesEnro a lot llees more he Wa ith lth care than the general 1 9 over a large work force (Figure 7). See Table I.C.1 in https://meps.ahrq.gov/data_stats/summ_tables/insr/national/series_1/2023/ic23_ia_g.pdf. 10 Copyright Information: This 8report is copyrighted by the Employee Benefit Research Institute (EBRI). You may incurred during the diagnostic, treatment, and post-treatment phases — make employers aware of the financial risks, e high A nr s out oll -cm ost lin ee nt d c la fo biy m r a (aH n full o ts r, r ow c w ahose le anda nd cr Kom e yss eb ae r ine lhe to dim a cvost , oid 20 s 2 inc w 3) ould on , th si rs a etc e ec nc oun prie im s a ta for rss y a o 24 p cia p p rto e ea d rc c e w he nitts t h of p o a tfin ot rtia a alnc l -spe yin ea g n r d C cing. G laTs im Me sa. re A a lnw e thoug mhil ere gh , ing tindiv he : la idu rge a ls may Employe 6 r Size Considerations im pop pr ula ovteion a . pa tient’s quality of life, butEmplo they com yme e wnt ith e -Base xtrem d ely Health high c ost Cov s. erage While only a limited number of CGTs are 6 DiMasi, Joesph A>, Henry G. Grabowski, and Ronald W. Hansen. 2016. "Innovation in the pharmaceutical industry: copy, print, or download this report solely for personal and noncommercial use, provided that all hard copies retain a 2 s 57 percent report that managing those costs are a top priority in their future pharmacy benefits (Belousova, Brown, 2 e m Sepeloy cita ertions would in H ha ov rro e w 10 a nd hig K he -c sost selhe cla im im (2023) ants a c fo cr ount the ire ng fe for renc only es th 1.2 p ey us eerd c.e nt of overall spending. r ae m ce oiv rtiz e a CtG ioT n, arcis ro kss spr meul at diple ing, ya end arsp , e w re for tr m ea at ned ce -e baacsed h ye paary a m s ea nt sep s. a rate cross-sectional observation. The annual sample It should come as no surprise that the largest employers are the least likely to purchase stop-loss coverage, as they approved, their use is growing, and more therapies are in the pipeline. As a result, the financial implications for 305 3 2018 2022 The financial impact of a CGT claim can vary significantly depending on the size of the employer. Larger employers New estimates of R&D costs." Journal of Health Economics 47: 20-33. doi:10.1016/j.jhealeco.2016.01.012. any and all copyright and other applicable notices contained therein, and you may cite or quote small portions of and Peel, 5 2025). 1 One size rg arnge oupd of from indiv aidua pproxi ls m rea qtuir elying 13ong milloing ion to or 1 int 9 m ens illion ive in cad re iv idua for a ls c . hronic condition is those who use cell and gene benefit most from the law of large numbers — a fundamental principal in insurance. This concepts states that as the employers and employment-based health plans are likely to increase over time. often self-insure their health plans, meaning they take on the financial risk themselves and directly pay the cost of the report provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing 1 . Amortization 0 therapies (CGTs). CGTs are two cutting-edge approaches in medicine that aim to treat or potentially cure diseases by size of a population increases, the average outcome becomes more predictable. In the context of health care, large Fronstin, Paul. 2024. "Trends in Self-Insured Health Coverage: ERISA at 50." EBRI Issue Brief, no. 616 (Employee Figure 8 4 claims incurred by their covered employees. In contrast, smaller employers are more likely to offer fully insured plans, While the pre 20 v10 alence 20 11 of rare 20 12 diseases 2013trea20 te15 d by C 20 G 16 Ts re20 m17 ains low 2018 , FDA 20 a 19 pprov 20 a20 ls and 20 r 21 eal-w20 or 22 ld utili 20z23 ation h 20a 24 ve requires EBRI’s prior express permission. For permissions, please contact EBRI at permissions@ebri.org. 24.7 Id In th ent is ify Issiue ng B C rie GT f, w Ues a us ge e c laims data to examine the evolving landscape of CGTs within employment-based health altering cells or genetic material within a patient. Very few people will ever receive a CGT. In 2020, 16,244 new employ 25 ers with many covered employees can better anticipate overall health care costs and are less affected by the Benefit Research II llns us tit tr ua te te ).d Impact of High-Cost Claimants, by Employer Size 23.7 w here they pay premiums to an insurance company that assumes the financial risk. In fact, only 16 percent of private- A st m ea or dtily iz ain tio crne a ased llow. s Deem spit ploy e e the rs ir to lim spr ite ed a dus the e, C cG os T use t of ar s Cm GT o ay v re ep r rte im sent e, ra a td he isrp r top haor n p tio ay na ing te tsh hea rful e l a of m ov oun eratll he upfr aon lth c t. are Source: www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/approved-cellular-and-gene-therapy-products p pla atns ient . W s w 3 e e arnea ly tre ze a ttehe d w pit re h a va le gnc ene e of the crond apyit ( ions Wong ta re gte a te l., d 2 by 02 C 3) G;Ts the , pya tatc ec roun ns in t tedhe for ra p jus y ut t 0.00 ilizat49 ion p , earnd cent the of btrhe oa der Report Availability: This report is available on the internet at www.ebri.org financial shock of a single high-cost claim. By spreading risk across a broad base of enrollees, they can absorb the cost Of the 48 CGTs approved by FDA to date, 27 had received approval by 2022. However, not all of these therapies were sector employers with fewer than 100 employees were self-insured in 2023, compared with 74 percent among spe Paynding ments c . Tr aa n b dite ion sta ru l c ctoust re -sh d e av ring enlym ov eceha r a ni p sm ers su iod of ch a yes d arse d or uc fr tible ont- s a loa nd deout d w-it of h sm -pocaklle etr m pa ay xim meum nts t s w he illr eha aft ve er .li tThese tle eff ect spe Frons nding tin, P im aul, a plicand tions M. fo Chr r e is nr top olle he ers w Roe ho buc usk e. t20 he19 se . t"he Perr asi pst iee s. nc Our y in Hi ana gly hsi -C s fur ost t H he ea rl thighl h Caight re Cs t laim hes: “ disIp t’rs Wh oporteion re a the te population. NuY m eb te trhe ofir E su mp bls oty ae nets ial price tags — combined with addition al costs incurr 1 e,d 0 0 d0uring the diagnost 1 00ic ,0, 0t0 reatment, of outlier events, such as claims for CGTs. In contrast, smaller employers, with fewer enrollees to distribute risk, face inc luded in our analysis due to a number of limitations. For instance, two CGTs were excluded because they were employers with 500 or more employees (Figure 6). Consequently, CGT claims may have a more immediate and direct a on rra us nge e of me he nta s c lth c an b are e ser mav dic e eds a irem ctong ly w it high h the -co C st G T m claim anu anfa ts,c tinc ure luding r or fin those anced r etc hr eioug ving h C aG tTs hir.d -party lender. The goal is to 2 c a onc nd p eost n 20 trSp a -t A trion o v e eea nding rt am gf e e C nt S G I p s, St T e pn -ha r de in ses upid la gt p e e d — ”r ." c E m ost m Ea B pk s lRI o e a ye e m Ie m ss ong p ue loy a Be rs rie s a m f, no. aw ll subse ar e 49 of 3t t (he of Em high fin ploy an -e c ce ost ia B l r ec is ne la kis, a fit m aRe n s 57 p ts sea and r$c e 8h I r ,e c 3e xplores 0 ns nt 0 t it re ut pe or e )m . t te hra gting mast n $8 a ra ,g 3ting 0 e0 gie tho s tse hat greater financial volatility from large claims and are therefore more likely to purchase stop-loss coverage as a protective a T pabl provee d o in f Cont late 2022, e wnt hiles ot hers could not be identified in the claims data due to the absence of specific billing budgetary impact on self-insured employers than on those with fully insured plans. align the cost of the therapy with the period over which its benefits are realized, potentially easing budget strain. Total Spending $8,300,000 $830,000,000 employerht s a tpnd s://ww insurw e.e rs m bri.or ay g c/pub onsid lic ea r ttions o m/arn ea sea ge rtche h- paublic ssoca ia tions ted fin /isa su ne c- ia bl rie risfs k/c s.on tent/persistency-in-high-cost-health- c B ost eca s us ise a of top the p rcio om ritp y le in t x a he nd ir tfut imur e-e int peha nsrim vea c re ysea bene rch, fits the (B e unc lous erov taa in, tB y rin t own, he asu nd ccP ee ss el, of 20 c25 linic ).a l trials, and the m Int eraod suuc ret.ion .......................................................................................................................................................... 4 c Eod mp es loy . Ad e1 r d sit ize iona pla lly ys , som a crit ei c the al r role apie in how s were fin no anc long ial r eri sk av a isila m ba le na in 202 ged. L 2a . rUlt ger im , self ately -ins , w ue rew d eerm e p aloy blee tro s b ana ene lyfit ze fr 12 om C G the Ts la and w individuac liz ar ee d- cor la is m m sa -it ll- -s b-aw tc he h na re-ttu he re- spe of C nding GT m -is anuf -stupid actur . ing, the cost of developing CGTs is significantly higher than that eight FDA-approved hematopoietic progenitor cell (HPC) cord-blood therapies in our study. of 2. la Rr is gk e num Sprea bed rs, ina gllow ing them to absorb high-cost claims by distributing expenses across a large enrollee base. In Current State of Cell and Gene Therapy .................................................................................................................. 4 K Te his y Fi Isnding sue H B ig s: rh ie -C f o us ste s C lc alia m im an s d t Ea xtp ae r to ie n ec xa emine the current landscape of cell and gene therapies (CGTs), including the 0 15 of traditional pharmaceuticals. Cell therapies typically range between $400,000 and $500,000 per treatment, while contrast, smaller employers are more financially vulnerable and often depend on stop-loss coverage to mitigate risk. 2018 2019 2020 2021 2022 Predicted Number of High-Cost Claimants 0.09 9 .2 Fronstin, Paul, and M. Christopher Roebuck. 2025. "Value-Based Pricing for Hospital Outpatient Services: A prevalence of treatable conditions and overall spending Fi by gu indiv re 7 iduals receiving these therapies. It also analyzes the Data and Study Sample .......................................................................................................................................... 6 A Ris m a kk n e-y yspr g stee ene a pd in our ing therm a p od aie na e s a ls ly r si d eis s p tin rrib iv colv e ut de e ov d the e ide r fin $1 nta ify m ncing ill ia ion, l im indiv a pnd aidua ct seve of ls i Cr G n th aT l a s r e ae c sa rp oss rm icp e m le d ult a w t ho iple $2r – e e 3 mi cnt eiv itlli ie ed on s , a m (C B uc G elous T h li . To kov e d taro , aA d this it lbe ion , rs, Ry we al ins re zu lie m ra o, dn o c Pn ee.e l, Figure 6 However, stop-loss coverage is an imperfect solution and may exclude coverage for known high-cost individuals • Rising Number of Approvals: As of 2025, the U.S. Food and Drug Administration (FDA) has approved 48 Actual Number of High-Cost Claimants 1 9 Among Self-Insured Plans, Percent of Private-Secto 10.9r Workers Enrolled share of D Ce Gm T-onst relarta etdio spe n Tha nding t Me arm ge ong s C ost use -r Es ffa ec crtoss ivene va ss riou Ana s c ly ost sis w thr ite h Re sholds. al-W Fi or na ld lly C,ost the D p aa ta p." er E b BrRI iefly Is su explores e Brief, no. pote nt 62 ia 5l Source: Employee Benefit Research Institute estimates based on administrative enrollment and claims data. 10.6 E seve and mploy P ra al ik ecr , od s c 20 ing ould 25)sy . c son tem trs ibut coe m tm o only a sh us are ed d fun in add m ori nis pur trca hta iv se e c rla eins imur s d aa ntcae: designed specifically for CGT coverage. Percentage of Private-Sector Establishments Offering Health Plans Identifying CGT Usage ....................................................................................................................................... 6 t hrough mechanisms like "lasering." CG ATs ve, ra w git e h S p m eo nr de in g in pd ee r v He iglop h-C m oe stnt C.l aA im g arnow t ing number of these therapie$ s a 1,0r0 e0 t ,a 00 rg 0eting condition $1,s t 000 ha ,0t0 0 are more in a Plan With Stop-Loss Coverage, by Firm Size, 2024 10 (Employee Benefit Research Institute). strategies employers may consider for financing CGTs moving forward. Contr 1ibut 00%ions would be based on group size and the projected incidence of CGT usage, which becomes more That Self-Insure at Least One Plan, by Firm Size, 2024 Total Spending on High-Cost Claimants $1,000,000 $9,000,000 90% common than traditional rare diseases. Calculating Spending From Health Care Claims .................................................................................................... 6 93% Beyond • the Hea cost lth c of ar the e Co CG m T i mto self, n Pr po at cie ed ntu s oft re Co en in din cur g Sy sus btem stant ( ia H l he CSPC alth ca S): ra e set of expens m ee sd tic hr aoug l cod hou es tus the edir t o hera elp th c resent are Spending Among Enrollees Who Are High-Cost Claimants To pred ad icd ta re bss le t ahe cro uni ss q laue rg efin r p aop ncula ial r tio isk ns s p . Thi oses dm bod y C eG l is Ts p , a ard td iciula tiona rlyl fi atna tra nccting ive m for od sm elsa lle —r su seclf h a -ins s ur am ed o re tiz maptloy ion, errs istkha - t lack Percent Spent on High-Cost Claimants 12% 1.1% Ghane • m, M Bo ut dh es aina t Growth h, Enrique in U Se soa e:ne Us -Va e of zqC ue Gz, TsL raew m re an ins ce lim Brow ited n, ba ut nd ha Rosa s sh ow Rod n ra igue grazd -u Mong al inc uio. rease 20. 23 In . 20 "Ana 18l, y7.9 p sis of etrhe 90% health care procedures, supplies, products and services. journey, making CGT users among the highest-cost claimants. A recent report by (Wagner, Sils, and Campbell, 2025) Findings ................................................................................................................................................................ 7 spr thee sc ad aing le to ma eb ch sor anis b rm ar s, a e, hig nd h p-ecrost for m cla anc ime s on -based the ip r a ow ym ne. nt arrangements — are emerging as other options. These 80% Figure 1 Overall, CGT users accounted for just under 0.1 percent of enrollees, and about 0.5 percent of 77% total spending. This 10 Ge0,00 ne Thera 0 enrp ol ie le s A esut re ho ceriv ize ed d a b yC G the T; b Unit y 20 ed22 St , atthe es Food rate r o ase nd tD o r9.2 ug A pd em r 10 ini0,00 strat0 ion . and the European Medicines 5 descr •ibe s t In his tern proc ati eo ss n a al C s alass fiveific -staa gti e o he n of Dis alth carea e “sod esy,ss 1e 0yth ” t R ha ev t cis an iospa n Pr n o seve cedr u arl e Co yeard s. in Ng ot Sy abs lytem , it ca (n ICD tak-e 1 0 up PC to S): a strategies may offer more tD ar is ge trtie b du , ti su ost na o ina f H ble ea w lth ay s t Sp o es n upp din or gt, a A cm ceo ss n g to IC nG dTs iv iw du hil ae ls m W an ith ag ing costs. However, in the Impact of Additional High-Cost Claimant inc lude Pre80 vs spe a %lencnding e of Se on lecC t G CTs ondit as w ions ell a Trs spe eated nding With C on Got Ts he ................................ r health care services. ................................ This number was in la .............................. rge part unchange d 7 • A Sm gea nc lly Sh ." Me are of Spen dical Care d 61 in ( g 7) : : C43 GT use 8-447. d rs reoi:10.1 presen09 t fe 7/ w ML erR. tha 00n o 0000 ne00 -te00 nt0 h o 01f o 84ne 0. percent of the enrollee 2.4 2.4 74% system used to classify medical procedures performed in hospitals and inpatient settings. 3 seve . Perf n ye oa rm rs t ao nc re ec -e Biv ae s ed an a Pc ac yur maen te td sia gnosis for 2.0 a r2.0 are disease. 70% context of C Act GTs ual, N the umse berfin ofa H nig ch ing -Cost str a Ctla eig m ie as nts may be promising but are in large part unpr2 oven. If they fail to p10 rove Employment-Based Health Coverage, 2022 71% between 2018 and 2022. 70% population but account for approximately one-half of one percent of total spending. This includes both the cost Trends in the Use of CGT ................................................................................................................................... 7 • Current Procedural Terminology (CPT): used to identify medical services and procedures. 70% Total Spending on High-Cost Claimants $2,000,000 $10,000,000 workable, payers may be left relying on traditional reimbursement approaches to address the costs associated with Horrow, Caroline, and Aaron S. Kesselheim. 2023. "Confronting High Costs And Clinical Uncertainty: Innovative Median Average Minimum 0 A One lso of know the of n a C fiv G s v e Ts st a a lue and ge-s in t b spe ased nding he p ur he c on ahltah c ot sing haer r e o he rj ou pa rlt r ic ne h se ing y , of rtvhis ic Ce G s. The a T u ppsers roa se c h ti is p rto e he p s p or fia trions st ym st e nt a hg as for e v eof r e “ C m A G w a Tine a s t red o ne r ce ss lin la ia tciv nd ae l o ly D u ia st tcg a onosi b m le e s b s.” . etw Pa eteie n nts’ 60% • National Drug Code (NDC): a unique 10-digit identifier that specifies the labeler, product, and package size Spending Pe A rce mn ong t Sp E en nr t olle on H eig s Wh h-Coo st A Crle a im Ha igh nts-Cost Claimants ................................................................ 24% ..................... 1.2% 8 Among the overall top 1 percent of spenders, 0.58 percent used CGT (Figure 5). They accounted for 1.6 percent of CGTs. Sickle C P el e l Di rcs een as ta ege of Per Sc pi enn alt Mu age sc o ulf ar A trS oph pe ynding per S He pmo en pd hiiln iag A per Spending p He er mo philia B Payment Models For Gene Therapies." Health Affairs 12 (11): 1532-1540. 60% 2018 and 2022. ® fir Em stp loy point ers, ins of con urtearc s, or p t is tyh pic ara m lly a cay p bre im ne afit ry m caarna e p greorv s (P ider B. Ms) Prov w ide ould r k now onlyle pd ag ye t he of rful arl p e d ris ice ea of ses a m CG ay T if i be tlim prit ov ed e, s e and ffec th tius ve, of Sourc a d e: rug EB. RI estimates using 2022 Merative™ MarketScan Commercial Database. Enrollees Spending Person Person Person spending among those in the top 1 percent of spenders. In other words, CGT users still account for a small share of 52% Financing CGTs ..................................................................................................................................................... 9 50% p ba at sed ie •nt on s m Im pary p e -a v dc is et o ifin t m n ed ul H tpiple ig ath ie -p nt Cro im - s or t C a rp ylaim op caula rea tp n ion rts ov -:le ide A vm e rs a l ong mnd e te rspe ic nr solle . cW iae hil lis in t stes. This im he ple t m op pr eo nt 1 p ce ing ss er c v ce ould ant lue of - tbat ak ot sed ea m l he a ont rraalhs t nge h ca or m ry e een a spe trs b s, le nde roa ad rds, ju ing ly tso t Future research should continue to explore the full spectrum of health care spending associated with CGT users, Source: EBRI estimates using 21% 022 Merative MarketSc 29% an® Commercial Dat $a 1 b5 a0 se,.000 $206,000 $96,000 P spe handing res, Sha 50% am ron, ongMa the rk highe Trushe st im us, erSa s of rah K hea . lE th c mond are, ser and vicSets. ev en D. Pearson. 2024. "Managing the Challenges of Paying W e gathe 0.58 red inf peor rce m nt a tus ion e d on CG reTle s. Ho vantw ce od ve ers fr , the om se m indiv ultiple idua sour ls ac ce co s, unt inc eluding d for 1.6 p the C ee rc netnt er s for of spe Me nding dicar e w it ahin nd Me tha dtic ta op id - r si eg m nif Ea m in ic pa s c loy nth eu a rse lle Singing ze of C he onsi a— lth c d ae s d raarte is ion cserv us s sed ................................ ice s b in (eFfor rons e a tin a form nd al d Roe ................................ iab guc nosi k, s is 202 m 5)a d — e . CD Gur Ts ................................ ing maty his b ep rm olong ore ceond d pe ur c ............................. iod ive — to fr out om com sye m-ptom 9 including the breakdown o5% f inpatient, outp 57% atient, and pha $5 rm 1,a 0c 0y 0-related c$ost 81,s. 00A 0 better unde $29,r0 st 0a 0nding of these patterns This example highlights how health care expenses related to rare, high-cost conditions have a disproportionately larger 40% for Gene Therapy: Strategies for Market Action and Policy Reform in the United States." Journal of Comparative Se b onset ased rvic e tp o s ( rspe ic dC ia ing MS g nding nosi b ) e pca sa y g us — m roup e e p n t ahe tt. ie b W ir ull nt hil ts oft e he t ein rta s he e p , n e indiv sh ut ge ia c ne r idu e er ff is aa e t l d e c st m s si ra ug g all, i nif rew itoft c ea si bnt e g si n na th esi e lss t g ,a nif lt 34% ahh c nd a ic t a a w C nt rG ide e Ts a cnd o ly st c us as m n me e (or The de m a m e nin Le d ea ic w g su a ful in G l c ra lod y br le oup im ing tp ha , arc I e n t nc tsour spe hose . 20 c nding e 23 sof . )B .ot e A pc he nd aatus tre on rens cCe G a Ts 40% 10% 71% $29,000 $51,000 $15,000 will be crucial for employers, insurers, and policymakers seeking to balance innovation with financial sustainability. Trend Self-s I ns inu r ta he nc e U a se nd of St op CG -L Tos s Coverage .............................................................................................................10 financial E im ffe pc atciv t e on nes ss m 13 alle (r5) e: me p24 loy 01 er1 s. 8. It helps explain why smaller self-insured employers are more likely to purchase are useda tm o ong trea thigh rare -c c os ondit t claiim ons, ant ts. he number of enrollees receiving any single therapy was small. As a result, our t dria ea gtnosi men s is ts. m How ade e, ve ar , pa the tiern et ha is not ve b a elw en ch ays d alle ee nge mes t d e ha ligib t hle av teo lim rec iteeiv de t he a C e Gff T. ec tiveness of performance-based payments 20% 84% $15,000 $30,000 $6,000 30% Figure 5 29% st op-loss coverage — to protect themselves from the outsized risk that even a single high-cost claimant can pose. Since 30 CG %Ts are associated with the treatment of rare diseases, use of CGTs is also rare. The number of CGT users has Illustration: Impact of High-Cost Claimants by Employer Size .................................................................................. 11 ® a nalysis combines cell and gene therapy users into one group. ( Belousova, Albers, Ryzmo, Peel, and Paik, 2025). Spending So o urc n e: HEB ea RI lth es tim Ca ate res u Se sin rg 2 vic 02 e2 M s, b era y tive Us ™ e Ma of rke GtS en cae n T Co he mrm aerc py ial , A Da m tab oas ng e. Top Spenders, 2022 Qiu, Tingting, Yitong Wang, Shuyao Liang, Ru Han, and Mondher Toumi. 2021. "The impact of COVID-19 on the cell increased slightly over the years. In 2018, CGT use was 7.9 per 100,000 individuals. It increased to 8.6 per 100,000 A As C lthoug GTs e h tv he olv num e from ber rof are a p to prm ovor ed e C com GTs m a on nd dtis re ea atse eda p pa ptlic ient ats ions rem , tahe ins r ir fin ela atnc ive ia ly l foo smtapllr, int the w la ithin ndsc ea m pp eloy is m ev eolv nt-ing based . Ne wer 20% Other Financing Options for Employers ..............................................................................................................12 16% While stop and -loss ge ne insu the rar nc ap eie cs indust an help rp yr :ot De iscrtupti self ons, op -insurep dor etm uni ploy tiee s, a rs fnd rom fut cur ate a sptrrospe ophic c tcs." laim Ds, it rug D isis not cov e ar p y eTod rfecaty sol 226 ution. - 20% Share of Spending individuals in 2019, 8.4 in 2020, and 9.4 in 2021, dropping slightly to 9.2 per 100,000 individuals in 2022 (Figure 4). health plans is likely to grow. Employers are beginning to explore innovative solutions to manage these costs, including t herapies are being developed for broader indications, including more common diseases (Braga, Filho, and Mota, 2022), Calculating Spending From Health Care Claims The vast majority of stop-loss carriers are covering CGT claims like other claims (Belousova, Albers, Ryzmo, Peel, and 2281. doi:10.1016/j.drudis.2021.04.020. Percentage of Mean Spending of Mean Spending of Median Spending of Median Spending of Accounted for by Study Limitations ................................................................................................................................................. 12 10% w sthic op-h coul loss ins d ur expa ancnd e, tche arv num e-oub t eprr og of realigib ms, g le e pne atie the ntsr a(p W yon reg ins eur t aal., nc20 e, 23 va)lue . B-yb a 20 sed 32 , p85 aym ne ent w g ae rrne ange the m ra ep nt ies, a s ar nd e expected Study 10% Limitations Enrollees Using Gene Therapy Enrollees Not Using Gene Therapy Enrollees Not Using Gene Therapy The Paik, fin 20 a25 nc) ia . l H im ow pa ec vte rof , nCot G T asll e high xtend -cost s b e cy la ond ims ta he re dful irely c tc c oost ver e of d tunde he the r trhe apse ies t polic hem ieselv s. In p es,a e rnc ticom ularp, asstsi op ng -loss a ra cnge arrie of rs Current State of Cell and Gene Therapy A fter the increase in CGT use from 2018 to 2019, there was a dip in use in 2020. The decline may have been related to p Ce onc rfor lum sia on nc ................................ e-based contracts. .......................................................................................................................... 13 to be approved (Phares, Trusheim, Emond, and Pearson, 2024). This expansion has implications for employers and Spe nding Tier Gene Therapy Users Gene Therapy Users Gene Therapy Users Quinn, Casey, Colin Young, Jonathan Thomas, Mark Trusheim, and MIT NEWDIGS FoCUS Writing Group. 2019. This study focused on CGTs, which are used to treat rare conditions. As such, several limitations should be noted: m ass ay o cliia mtit e dc ov expe erans ge e s for , a s d speis cc ifus ic sed indiv aidua bove ls. w To ith cakp now turen hig the h ful -cl sc ostop pre e e of xis the ting se cc ond osts it, ion we s a thr gg oug regh ata e d p rta ot ctail ce spe know nding n a for s 0% C the ell a COVI nd 0%g De-ne 19 tp he ande rapm ies ic , (C w Ghi Tc sh p ) arut e a a rsi eg lanif tivic ea lynt ne sw tra fr inon ot nie trhe in m hee ad ltic h ine car, eoffe deliv ring eryt he sy sp te ot m e.nt There ial to tr we aa s ta or sh poot rte an gteia of lly health plans. 1% Fewer Than 0.5 10 8% 0 Employees $569,000 100–49 $2 9 0 E 4 m ,0 pl0 oy 0ees $468,000 500 or More E $1mp 49l,o 0 y0 e0 es 1.60% "Estimating the Clinical Pipeline of Cell and Gene Therapies and Their Potential Economic Impact on the US References ................................ Total Fewe ................................ r Than 10 10–24 Emp................................ loyees 25–99 Employees................................ 100–999 Employees .......................... 1,000 or More 14 e “ la ac seri h eng nrolle .” Und e. S ep r e la cser ifica ing, lly, tw he e su polic mm y’e s d d tehe duc atllow iblee is d set a amou t nt ors ne fro am r tinpa he etxpe ientc, te out d cpos attie of nt,t ra end ating pha ar m paarc tic y ula clarim es nrtolle o e, c eur quipment e diseases , and byhospit targetaing l reso the ur irc r eoot c s likea us bee ds s a atnd the m c ee dllu ica la l ve r or nt g ila ene torts icw le ev re e l.p r Cior ell t itize hed ra for pie s w COV or Ik D -b19 y int partod ient ucsing . Som new e or Understanding the trajectory and implications of CGTs is critical for employers, policymakers, and health plan sponsors. Employees Employees 1. Small Sample Size: Due to the rarity of the conditions treated with CGTs, the number of enrollees receiving these 2–5% 0.04% $58,000 $50,000 $58,000 $44,000 0.05% Healthcare System." Value Health 22 (6): 621-626. doi:10.1016/j.jval.2019.03.014. effectively excluding or minimizing reimbursement for that individual’s care. This technique is often used to manage calculate annual total spending per enrollee. C m Endno G od Ts ifi , e tsu e ds c c................................ h a ellss int CAR o t-he T c b eod ll ty he tr o ar pe ................................ ie st sor , re e q fun uirc et ion o continu r fight ou................................ s m disonit ease. oring Gene and the evra alp u ................................ ie ats inv ion o olv f te he a lt pe arting ienta , w p ............................ e hic rso h w n’s g as not enet ics to 15 While curre So nt u rcut e: ili Fro za nst tiion a n, Paul, nd “Selspe f-Insunding red Hea lth re Cov me ara in lim ge From it e 19d 9, 6 to the 20 2p 4,” ipe EBRI I line ss uof e Bri the ef, nroa . p 64ie 2 (Em s apn lod ye t ehe Ben ir e fihigh t Reseac rcost h Ins w stitutea , r Au ra gu nt st 2c 8lose , As CGT use So e urc xpa e: Fro nds nsti, n, t Pa ra ud l, “Se itio lf-na Insu l c redos Hea t-lc thon Cov tr eol ragem Fro ec mh 1a 99nis 6 tom 20s 24m ,” EBRI I ay psr sov ue Bri e eina f, nod . e 64q 2ua (Emtp e lo . yFor ee Be n e exa fit Res mp eale rc, h Id nse tid tuuc te, Au tible gust s2, 8, long used 6–10% 0.02% $21,000 $20,000 $21,000 $20,000 0.02% therapies in our dataset was very low. In particular, the number of individuals with total spending exceeding $1 million 2025). Available at www.ebri.org/health/publications/issue-briefs/content/summary/self-insured-health-coverage-from-1996-to-2024. 2025). Available at www.ebri.org/health/publications/issue-briefs/content/summary/self-insured-health-coverage-from-1996-to-2024. stop-loss premium costs. Conditions frequently subject to lasering include cancer, end-stage renal disease, premature p c or oss reible ct o d r ue com to pe const nsatr ea for ine d fa rult esour y ge cne es.s. The The dU. isrS. upti Food on of and actD ivrit ug ies Aw dm ith ini tr st arva etl ion a restrpic ptrio ov ns ed , ctonc he fir erst ns C of GT in transm 2010 iss ion (Fig of ure t ao ttm ent an ion to e age hens altur h p e la su n sp staina ending ble a, ca creess unl and ikeb lye ne to fit sig d nif esi icg an ntin t ly a he ffe y ce t a crost s as for head C . GT users. Most deductibles fall far below 11–20% 0.01% $11,000 $10,000 $10,000 $9,000 0.01% w The as in t Lewhe in G sir ngle oup , dIigit nc. s, 20 lim 23 it.i ng The the Cost rob of usD tne ela ss y e of d a Dna iag ly nosi ses a s in Ra t highe rer D spe isending ase: A tH hreeash lth ol E dc sonomi . c Study. EveryLife ® births, and organ transplants. COVID-19 to patients, and supply constraints could have been the reason for decreased use of CGTs in 2020 (Qiu, Sourc 2) e: . EB ByRI 20 es 2 tim 5, ate 48 s u Csin GT g 2 s ha 022 M d b era ee tive n a ™ pp Ma rov rkee tS dca . n Commercial Database. the typical minimum $6,000 in annual spending by high-cost claimants (Fronstin and Roebuck, 2019). The high cost of Foundation for Rare Diseases. Accessed March 3, 2025. https://everylifefoundation.org/wp- Wang, Liang, Han, and Toumi, 2021). 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