The healthcare industry has seen significant growth in transplant, cell, and gene therapies over the past decade, with treatments available for conditions ranging from cancers to spinal muscular atrophy.
However, as more treatments become available, payer organizations face increased complexity in care plans and heightened costs.
Challenges in Transplant, Cell, and Gene Therapies
Managing these conditions requires deeper integration across clinical care, decision making, patient support, and care access, according to the report.
Lisa Latts, MD, Chief Medical Officer at Optum, noted that these are not typical care journeys.
Latts, along with colleagues Michael O’Day and Marjorie Chen, emphasized the importance of combining clinical guidance, active care management, and access to high-quality care centers to support these specialized treatments.
Transplant Trends and Costs
Recent increases in organ donation rates and improved treatment of potential transplant complications have led to a rise in transplant utilization.
The average cost of a transplant is approximately $892,000, according to Michael O’Day.
O’Day stated that even slight changes in utilization and costs can significantly impact the overall exposure for health plans.
The use of genetically modified animal organs, known as xenotransplantation, has also expanded the number of available organs for transplant.
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Gene and Cell Therapies
Cell and gene therapies offer cures for previously intractable conditions, but are also the highest-costing treatments globally.
Marjorie Chen explained that these innovative approaches involve greater clinical complexity and financial impact for health plans.
Chen noted that health plans need end-to-end solutions to manage complexity, cost, and risk associated with these therapies.
As the number of cell and gene therapies increases, payers must apply more sophisticated contracting approaches to manage costs and outcomes.
This may include specialized provider networks with disease-specific centers of excellence and case rate pricing, reinsurance, and full-risk transfer models.
Latts, O’Day, and Chen emphasized the need for proper coordination to make treatment more cost-effective, including care coordination, patient education, and clinical oversight.
By providing this coordination, health plans can improve outcomes and manage costs, according to Chen.
The 2025 U.S. organ and tissue transplants report by Milliman provides further insight into the estimated costs and utilization of these treatments.
Health plans can use this information to inform their strategies.