Sustainability in Healthcare: Actuarial Approaches for Funding Innovative Therapies

Innovative gene and cell therapies have the potential to cure previously incurable conditions and to transform millions of lives. However, their high cost are already challenging healthcare budgets and creating new risks.   Insurance coverage and patient affordability are critical considerations in the funding of  innovative therapies and the sustainability of healthcare systems. Even the most innovative therapies must be accessible to patients to have a meaningful impact. Actuaries and clinical professionals in health insurance companies play a pivotal role by determining coverage and reimbursement rates for new treatments.  Successful negotiations with insurers can ensure that therapies are included in health plans, making them accesible and more affordable for patients. Reinsurance mechanisms, risk pooling, and outcomes based reimbursements strategies can help manage the risks associated with one-time very high cost treatments that often replace the costs of life time maintenance therapies, disease progression, and disability. Additionally, patient assistance programs and subsidies can help reduce out-of-pocket costs, ensuring broader access to cutting-edge treatments.