Stop-Loss Gene Therapy Landscape
The stop-loss market's response to gene therapy has been fragmented. Some carriers exclude gene therapies entirely; others cover them at standard specific attachment points; others offer specialized gene therapy programs with higher attachment points or separate coverage. The market is evolving rapidly — what was available in 2024 may not be available in 2026.
Gene Therapy Stop-Loss Programs
- Standard coverage: Gene therapies covered at standard specific attachment point (most favorable)
- Sublimit coverage: Gene therapies covered up to a sublimit (e.g., $2M per member)
- Separate program: Gene therapy coverage purchased separately from standard stop-loss
- Exclusion with carve-out: Gene therapies excluded from stop-loss but covered through a separate risk pool
- Full exclusion: Gene therapies excluded entirely (most unfavorable)
Reinsurance Pools
IQ Insight
Reinsurance pools for gene therapy — programs that pool gene therapy risk across multiple employers — are an emerging solution to the gene therapy coverage challenge. Programs like Berkley One's gene therapy reinsurance pool and Symetra's gene therapy program provide coverage for gene therapy claims above a threshold. These programs are worth evaluating as an alternative to traditional stop-loss for gene therapy.