How Cell and Gene Therapies Can Bankrupt Unprepared Employers with Tom Sondergeld | Only Healthcare Podcast #24

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 coalition

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Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

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/.