Episode 24 |How Cell and Gene Therapies Can Bankrupt Unprepared Employers
- Only Healthcare Podcast
- Oct 31
- 3 min read
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In this episode of Only Healthcare's Risk Series, hosts Michael Navin and Randy Vogenberg welcome Tom Sondergeld, managing partner of TS Consulting Group with over 30 years in healthcare benefit consulting and former senior advisor to McKinsey & Company. As a national leader in benefit design strategy and cancer survivor who has personally navigated the healthcare maze, Tom provides both professional expertise and patient perspective on the explosive growth of ultra-high-cost therapies threatening to devastate employer-sponsored health plans.
With 3,700 ultra-high-cost therapies in development and 30+ cell and gene therapies already approved by the FDA, Tom reveals how employers—especially mid-size companies with $2-4 million annual plans—face potential financial catastrophe from single claims reaching $4-7 million. Drawing from his experience managing benefits at major companies like Walgreens, he exposes the systemic failures that leave even healthcare experts lost in prior authorization labyrinths while outlining innovative solutions for survival.
Key Topics Discussed:
The $24 Million Reality Check for Large Employers - Predictive analytics reveal that large employers with massive populations likely face 6+ employees needing ultra-high-cost therapies at $4 million each, creating $24 million exposures that are increasingly difficult to hide, while mid-size employers with $2-4 million total plans face doubling of costs from single claims hitting at the worst possible times
The Prior Authorization Hell Even Experts Can't Navigate - Tom's personal experience being lost in prior authorization systems despite 30+ years of healthcare expertise, unable to reach decision-makers or understand requirements, highlighting how the system sidelines patients when they need advocates most, with navigation becoming a "magical" skill that third parties possess but patients and employers lack
Breaking Down Healthcare's Wall Between Stakeholders - The artificial separation between pharmaceutical manufacturers, providers, and employers that prevents direct conversations and cost management, with successful examples like Boeing and Caterpillar achieving demonstrable savings through direct contracting, while traditional middlemen create opacity that benefits no one except intermediaries
The episode reveals that employers must abandon traditional "peanut butter" formulary approaches and embrace value-based benefit designs that connect high-cost therapies with comprehensive care programs, while building coalitions to achieve the 2-3 million member risk pools necessary for predictable cost management.
🎧 Listen now: onlyhealthcarepodcast.com
Hosted by: Michael Navin & Randy Vogenberg, PhD
Guest: Tom Sondergeld, Managing Partner, TS Consulting Group
Chapters:
(00:00) Introduction
(03:00) Ultra-high-cost therapy pipeline: 3,700 treatments coming
(08:00) Manufacturer-employer partnerships emerging
(11:00) Large employer awareness gaps on therapy exposure
(16:00) Reference-based pricing and purchasing alliance solutions
(22:00) Prior authorization nightmares: lost in the system
(26:00) Emotional vs. financial decision-making frameworks
(29:00) Manufacturer warranties and risk-sharing innovations
(32:00) Large employer coalition leadership imperative
(36:00) Value-based benefit design implementation strategies
(37:00) Conclusion
Hosted by:
Michael Navin & Dr. Randy Vogenberg
For feedback or to suggest topics for future episodes, reach out to us at onlyhealthcarepodcast@gmail.com.
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Hosted by: Michael Navin & Randy Vogenberg, PhD
This Podcast is sponsored by:
Peek: Peek is reimagining access through innovation, technology, connectivity, and partnership. Peek offers a comprehensive and unique suite of solutions to help clients improve access and affordability for prescription drugs.
The Peek Meds Marketplace is one of Peek’s differentiated offerings that gives employers a revolutionary new approach to controlling runaway prescription costs for their employees by providing unprecedented transparency, simplicity - and cost savings. The Peek Meds Marketplace aggregates cash discount cards, manufacturer copay offset programs, and an employee’s insurance information to provide a holistic and personalized view of prescription price options. This easy-to-use platform offers a one-stop-shopping experience for prescription drugs.
Peek’s team has decades of experience in the pharmaceutical industry and offers various services to biopharma manufacturers, brokers, benefits consultants, third-party administrators and employers. Visit peekmeds.com to learn more.
Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.
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