Risk Pooling Mechanisms
| Mechanism | How It Works | Best For |
|---|---|---|
| Stop-loss with gene therapy coverage | Standard stop-loss covers gene therapy at specific attachment point | Employers with favorable stop-loss terms |
| Specialized gene therapy reinsurance | Separate reinsurance program for gene therapy claims | Employers whose stop-loss excludes gene therapy |
| Industry risk pool | Multiple employers pool gene therapy risk | Smaller employers seeking scale |
| State reinsurance program | State-sponsored reinsurance for high-cost claims | Employers in states with reinsurance programs |
Evaluating Risk Pools
Evaluate gene therapy risk pools on: (1) coverage scope — which gene therapies are covered?; (2) attachment point — what is the threshold above which the pool pays?; (3) premium — what is the annual cost of pool membership?; (4) financial stability — is the pool adequately capitalized?; and (5) claims history — has the pool paid claims as promised?
Annual Evaluation
Pro Tip
The gene therapy risk pooling market is evolving rapidly — new programs are launched and existing programs change terms frequently. Evaluate your gene therapy risk management strategy annually. What was the best option in 2025 may not be the best option in 2026. Work with a stop-loss broker who specializes in gene therapy risk management to stay current.