Curative gene therapies are no longer theoretical. The controversy now is financial: how to pay for treatments that cost more than a house but may eliminate decades of medical expenses.

Health systems are experimenting with outcome-based contracts, spreading costs across multiple years and linking payments to patient results. Manufacturers argue that pricing reflects research risk and small patient populations. Payers counter that budgets are finite, and rare diseases are not rare in aggregate.

Patient advocates fear a two-tier world where access depends on geography and insurance. The next negotiation cycle will likely set precedents for how medicine values cures in the years ahead.