CGT Insurance Coverage

Purpose-built protection for high-cost therapies

Cell and gene therapies, including CAR-T therapies, drive better outcomes but create multimillion-dollar
volatility for self-insured employers. Our stop-loss and reinsurance coverage solutions stabilize costs and enable
access to life-changing care with financial control.

 
 
 
 

Coverage Options

Full Coverage

Most cost-effective option for

groups with 51 to 5,000 EEs

Comprehensive coverage and services

Complementary to stop-loss coverage

Covers specific deductibles in excess of $40,000

100+ Centers of Excellence network

Concierge patient support services​

Cost management for known CGT cases​

Risk Sharing

Tailor-made plans to reduce PEPM for 1,000+ EEs

 

Same benefits as Full Coverage

Higher deductible reduces PEPM premium​

Variable coverage options:​

+ Selected gene/cell therapies​

+ With or without administration coverage

 

Services Only

Most cost-effective option for

groups greater than 10,000 EEs

Utilization Management

100+ Centers of Excellence network

Drug discounts

Concierge patient support services

Claims management and/or repricing

Group self-funds claims

Affordable cell and gene therapy coverage with complementary patient support

The industry's most comprehensive solution:

  • All Gene Therapies
  • All FDA Approved CAR T-cell Therapies
  • Coverage for Ancillary Medical Expenses
  • Coverage for Family/Patient’s Travel-related Expenses
1. Standard coverage includes all FDA approved single administration gene therapies that are $850k and greater. Employer groups can select their covered therapies. 

Deliver Financial Stability to Your Clients

We recognize the essential role the insurance brokerage community plays as trusted advisors, guiding clients through complex and emerging business risks.

That’s why OutcomeRx partners closely with brokers to educate employers on the rapidly evolving cell and gene therapy (CGT) landscape. Together, we deliver flexible, comprehensive cell and gene therapy insurance coverage solutions designed to address the financial exposure these therapies present — protecting both the organization and its employees.

We collaborate across the full brokerage spectrum, including wholesale specialty brokers, retail brokers and agents, employee benefit brokers and consultants, and reinsurance professionals.

Learn More About Cell and Gene Therapy Insurance Solutions

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