A recent report from Pharmaceutical Strategies Group (PSG) reveals that over 70% of health plans and employers anticipate that the affordability of gene therapies will present a 'moderate or major challenge' in the coming years.

This analysis is grounded in feedback from more than 230 health benefits executives who attended the Asembia ASX25 conference in Las Vegas.

Interestingly, nearly 40% of health plans do not utilize financial protection products to mitigate risks associated with the high costs of cell and gene therapies.

PSG's COO, Rebekah Gregg, underscores the necessity of data transparency and insights for health plans to navigate rising cost pressures while ensuring access to essential medications.

In response to escalating costs, 65% of health plans have adopted preferred drug strategies for Humira biosimilars, indicating a shift towards more cost-effective treatment options.

The report highlights that health plans are increasingly managing specialty drug costs by favoring less expensive biosimilars of high-cost drugs like Humira, which can exceed $50,000 per patient.

Renee Rayburg from PSG points out that gene therapies are complex, with varying patient eligibility and treatment processes, emphasizing the need for expert analysis to guide health plans.

The U.S. market is poised for the launch of nearly a dozen new cell and gene therapies in 2025, with treatment costs potentially reaching $475,000 for conditions like acute lymphoblastic leukemia and exceeding $3 million for hemophilia B.

While cell and gene therapies are emerging as critical life-saving treatments, their exorbitant costs create significant challenges for health plans and employers.

Specialty drugs already represent a substantial portion of prescription spending, with some employers reporting that these costs account for over 60% of their total drug expenditures.

Despite recognizing the potential financial impact of these therapies, 73% of health plans express low confidence in their understanding of these challenges.