RARE Daily

Quantile Health Raises $6 Million to Transform Patient Access to Gene Therapies

March 1, 2024

Rare Daily Staff

Quantile Health, co-founded by MIT Professor Andrew Lo with the aim of solving the problem of patient access to transformative treatments with an innovative access model, has raised $6 million.

Munich Re Ventures lead the round with support from First Round Capital and Correlation Ventures to expand its payer partnerships and manufacturer network.

Gene therapies represent a promising future of treatments, but at a staggering cost. The cost of a single gene therapy can exceed $3 million, equivalent to the entire annual health insurance budget for a smaller, self-insured employer plan. With more than 120 million Americans receiving health insurance under employers’ self-insured plans, this potential budget risk has caused nearly a third of all self-insured plans to drop coverage for gene therapies. Even more are considering dropping coverage in the coming years.

According to Quantile Health, the fee-for-service model is simply not working for gene therapies. In human terms, this means children with fatal conditions and patients with excruciating pain are denied life-saving treatments. The approval of Casgevy and Lyfgenia for sickle cell disease this past December makes the need for a new payment model even more pressing.

With backgrounds in financial engineering and insurance, Quantile Health’s team understands the complex issues at play, and has developed a unique risk transfer platform for U.S. payers and gene therapy manufacturers. Instead of paying for each treatment, payers and employers of all sizes can subscribe to the right to access treatments directly from manufacturers. The payer pays a fixed cost reflecting the underlying risk of their population without having financial exposure to catastrophic tail risk scenarios.

For example, instead of a single patient’s gene therapy costing more than $3 million, the average self-insured employer could subscribe all of its employees to the gene therapy access for less than $1,000 a year. This aligns incentives and represents a major improvement for everyone: pharmaceuticals get increased coverage for their therapies, payers mitigate financial risks at lower cost, and most importantly, patients get unfettered access to lifesaving treatments.

“Investors can do well by doing good,” said Lo. “Quantile now has the funding to do it for the many life-saving gene and cell therapies under development.”

Photo: Quantile Health, co-founder Andrew Lo 

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