National Risk Pool Would Spread Cell, Gene Therapy Costs Across Payers

The Alliance of Community Health Plans (ACHP) and the Academy of Managed Care Pharmacy (AMCP) are advancing a national risk pool proposal designed to spread the cost of the most expensive cell and gene therapies across all payers, according to Carmen Witsken, PharmD, senior manager of pharmacy policy at ACHP.

In part 2 of an interview at AMCP Nexus 2026, Witsken, a panelist for the “From Pipeline to Patient: Navigating the Next Wave of Cell & Gene Therapies” session, outlined the proposal’s 4 main elements. First, payers across all lines of business would participate, creating a large enough patient population to spread the costs of these therapies.

Second, payers would contribute to the pool through per-member-per-month fees. Witsken noted that these first 2 elements are closely linked; without enough participants to spread the costs, the risk pool would become unaffordable, as has been the case in the private market.

The proposal would also enable outcomes-based contracting, she said, bringing manufacturers and health plans together to agree on predetermined outcome-based contracts. Because all payers would participate, these contracts could follow patients regardless of their health plan or whether they move. Witsken described portability as a major advantage that would also help track outcomes.

Third, an administrator, either the federal government or a private entity without stakeholder interests, would oversee the pool. Fourth, the pool would not cover all cell and gene therapies; instead, it would focus on the most expensive and least predictable therapies, particularly those for rare diseases, that health plans are struggling to finance while remaining viable.

Although many details remain to be determined, Witsken said ACHP has been encouraged by its collaboration with AMCP and its members on the proposal.

“…patients deserve access to the therapies that they need in order to treat and sometimes even cure whatever disease they are facing,” she concluded. “The ability for patients to get that access should not depend on where they live or the health plans that they have access to. We are proposing a solution that could solve that financing problem.”