Toward equitable access to cell and gene therapies: rethinking co-payments

Cell and gene therapies represent a transformative advance in the treatment of inherited disorders, hematologic malignancies, and progressive neuromuscular diseases, offering the potential for durable remission or cure. However, with onetime therapies now routinely priced above $3 million, their integration into the US health care system presents significant challenges related to affordability, access, and equity. Although patient cost sharing represents a small fraction of total cell and gene therapy spending, deductibles and coinsurance can expose commercially insured and Medicare beneficiaries to thousands of dollars in out-of-pocket costs, creating meaningful financial barriers for patients and families already burdened by illness-related economic strain. This article examines the role of co-payments in the context of high-cost, physician-administered, curative therapies and evaluates whether traditional cost-sharing rationales remain applicable. Drawing on emerging evidence from chimeric antigen receptor T-cell therapy utilization, we highlight persistent disparities in access by race, socioeconomic status, geography, and insurance type and discuss how patient cost sharing may exacerbate inequities in a category characterized by strict clinical eligibility, intensive oversight, and minimal risk of inappropriate use.