Gene and cell therapies are beginning to enter the market, and they are ushering in a new era of medicine. This paper introduces why self-insured employers with stop-loss coverage may still be exposed to some of the costs of gene and cell therapies, explores considerations and a potential imbalance of financial risk for the self-insured employer and stop-loss carrier when implementing a multiyear performance-based payment arrangement, and discusses potential ways to efficiently contract between the self-insured employer, stop-loss carrier, and manufacturer to better share the financial risk.

This report was commissioned by bluebird bio, a manufacturer of gene therapies.