The Financing and Reimbursement of Cures in the US (FoCUS) project was created in 2016 “with the aim of developing precision financing solutions that address the challenges and financial impact created by durable cell and gene therapies entering the US market”. To gain a better understanding of how the market was reacting to these advancements (there are currently seven durable cell and gene therapies approved in the US market at the time the report was created¹ and 362 cell and gene therapies in development²), FoCUS sent out a 45 question RFI to a list of known organizations that may be working on products to support patients and health plans from uncertainty and actuarial risks.
BCS Financial was one of 12 companies that responded with our Stop Loss GT product. Stop Loss GT offers large, self-funded employers financial protection from FDA-approved gene therapies that traditional higher deductible stop loss insurance may not impact. For this survey, there were seven total products within our category (Payer reinsurance/stop-loss/risk carve out solutions) with a broad range of coverage from Actuarial/Financial to Patient Access.
The purpose of the white paper was not to rank products from best to worst, but to gain a better understanding of the market’s response to this growing industry. Advanced cell and gene therapies offer the promise of potential cures for disease and genetic disorders yet come at unprecedented costs. With an estimate of an increase of billions of dollars in premiums over the next four years, knowing the gaps within the health insurance industry will be vital to providing the best response.
The findings of the paper show that though there are multiple products available that are designed to “support the variety of needs of stakeholders associated with the reimbursement of durable cell and gene therapies”, no one solution can address all of complexities that surround these advancements. The three key challenges the report highlights (payment timing, performance, and actuarial risk) still have gaps that need to be met. In the interim, stakeholders may need multiple products to protect against risk, which fortunately are currently available to them, including Stop Loss GT from BCS Financial.
For a version of the full report, please click here to visit the FoCUS website. For more information about the Stop Loss GT product, please contact Chris Bailey at [email protected].
