OutcomeRx Insurance Management Services

What OutcomeRx Insurance Management Services does

OutcomeRx Insurance Management Services, LLC is a privately held specialty insurance manager founded in 2019 and headquartered in Orlando, Florida. The company designs and administers insurance, reinsurance, stop-loss, and warranty products specifically for cell and gene therapies (CGTs), which carry per-patient costs that frequently exceed $2-3 million and are not adequately covered by traditional stop-loss structures. OutcomeRx serves self-insured US employers across three tiers — Full Coverage (51-5,000 employees), Risk Sharing (1,000+ employees), and Services Only (10,000+ employees) — with all tiers providing access to a network of 100+ Centers of Excellence, concierge patient support, and travel-expense reimbursement. In May 2023, CGT Solutions, LLC acquired OutcomeRx from CareMetx, LLC, which retained a minority interest; CEO Joe Morse leads the combined entity. The company also operates the Association for Cell & Gene Therapy Solutions (ACGTS) membership sub-brand and in May 2026 launched CGT Solutions Stop-Loss, a stand-alone stop-loss product covering up to $4.5M per claim and underwritten by A.M. Best A-rated Fidelity Security Life Insurance Company. Distribution runs exclusively through licensed insurance brokers, wholesale specialty brokers, employee benefit consultants, and reinsurance professionals, with the company positioning itself as an independent, payor-agnostic partner that integrates without disrupting existing vendor relationships.

Name

OutcomeRx Insurance Management Services

Legal name

OutcomeRx Insurance Management Services, LLC

Website

https://outcomerx.com

Company type

Private

Founded year

2019

Operating status

Operating

Headcount range

1–10 employees

Short description

OutcomeRx designs and administers specialty insurance, stop-loss, reinsurance, and warranty products for cell and gene therapies, serving US self-insured employers through licensed brokers and offering access to 100+ Centers of Excellence.

Ownership category

akta.pro rank

Product category

Specialty Insurance

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Insurance Agents, Brokers & Service (6411), Accident & Health Insurance (6321)

akta.pro primary industry

Stop-Loss & Reinsurance Administration (Captive/Level-Funded Support) (HLAEALAB)

akta.pro secondary industries

Stop-Loss & Excess Loss Coverage (Employer Sponsored) (HLAEAAAF), Self-Funded (ASO) Group Health Plans & Stop-Loss (FSAIAFAB)

Keywords

• Stop-loss insurance
• Cell and gene therapy
• Reinsurance solutions
• Specialty drug coverage
• Employer benefit plans

Headquarters

HQ city

Orlando

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Others, Infrastructure

Revenue model

1. Insurance Premiums (Stop-Loss and Reinsurance): OutcomeRx generates revenue through stop-loss and reinsurance premiums charged to self-insured employers. The Full Coverage option is described as the most cost-effective for groups with 51 to 5,000 employees. Risk Sharing plans use higher deductibles to reduce PEPM (per employee per month) premiums for groups with 1,000+ employees.
2. Therapy Warranty Programs: OutcomeRx designs and administers therapy-specific warranties that align clinical and financial outcomes between plans and manufacturers. These warranty programs mitigate financial risk and uncertainty for cell and gene therapies, generating fees from both payors and manufacturers.
3. Association Membership (ACGTS): The Association for Cell & Gene Therapy (CGT) Solutions offers membership with reinsurance coverage exclusively to members, generating membership fees from eligible employers.
4. CGT Solutions Stop-Loss: Stand-alone medical stop-loss insurance product that reimburses covered expenses on qualified claims for Gene and CAR T-cell therapies, underwritten by Fidelity Security Life Insurance Company. Available to self-funded employers through licensed brokers and consultants.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels5 records

Core offering

OutcomeRx provides specialty insurance, reinsurance, and stop-loss coverage solutions designed specifically for cell and gene therapies (CGTs). Its core offerings include Full Coverage and Risk Sharing plans for self-insured employer groups, Services Only arrangements for very large groups, therapy-specific warranty programs administered as an independent third party, and the CGT Solutions Stop-Loss product underwritten by Fidelity Security Life Insurance Company covering up to $4.5M per qualified claim. The company operates the Association for Cell & Gene Therapy Solutions (ACGTS) membership platform to deliver education and reinsurance access to members.

Product overview

OutcomeRx Insurance Management Services offers a portfolio of insurance and reinsurance solutions for cell and gene therapies (CGTs). The core offerings include Full Coverage and Risk Sharing plans (for groups of 51-5,000+ employees), Services Only (for 10,000+ employee groups), Cell & Gene Therapy Warranty programs, and CGT Solutions Stop-Loss (launched May 2026, covering up to $4.5M per claim). All plans provide access to 100+ Centers of Excellence and patient support services. The company also operates the Association of Cell and Gene Therapies as a membership and education sub-brand. Solutions are backed by A-rated carriers and integrate with existing payor ecosystems.

Differentiator

Problem solved

Functional benefit

Brands

• Association for Cell and Gene Therapy: An association promoting education to all stakeholders to expand knowledge and best practices for the advancement of patient access and affordability. Operates under cgtsolutions.outcomerx.com.

Products and services

• Full Coverage

Quantifiable outcome

• Coverage for treatment costs up to $4.5M per qualified claim
• +3 more outcomes

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Partnerships

Two partnerships are on record, tiered major and minor.

• CareMetx, LLCmajorStrategic or Co-development Partner · 15 May 2023CareMetx, LLC sold OutcomeRx (a division of CareMetx) to CGT Solutions in May 2023. CareMetx retains a minority interest in OutcomeRx. CareMetx CEO Jim Rowe stated continued support for OutcomeRx solutions. Co-founder Mark Hansan serves on the Board of Directors of CGT Solutions.
• CGT Solutions Association (ACGTS)minorStrategic or Co-development PartnerThe Association for Cell & Gene Therapy (CGT) Solutions promotes education and provides reinsurance coverage exclusively to members. OutcomeRx offers its solutions through this association platform, with contact information at [email protected] and (321) 467-7846.

Scale indicators7 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Cigna (Evernorth): Through Evernorth, Cigna operates specialty pharmacy and PBM businesses that intersect with high-cost therapy management similar to OutcomeRx's CGT focus. As a major health services conglomerate, it has the scale to develop competing CGT coverage offerings.
• Symetra Financial: Symetra Life Insurance Company is a major stop-loss carrier with a strong focus on self-funded employer groups. Its product breadth and broker distribution make it a relevant incumbent peer for OutcomeRx's self-insured employer target market.
• Sun Life Financial: One of the largest stop-loss insurance carriers in the U.S. through its Sun Life U.S. business, serving self-insured employers with broad coverage. Comparable to OutcomeRx as a stop-loss provider but operates at vastly greater scale across all employer segments, not just CGT.
• Voya Financial: Voya's stop-loss business is a top-tier provider for self-funded employer plans, with deep broker relationships across the U.S. Like other incumbents, it is well-positioned to add CGT-specific coverage to its portfolio, posing direct competitive risk to OutcomeRx.
• Munich Re: One of the world's largest reinsurers, with significant exposure to life and health reinsurance. Relevant to OutcomeRx as a potential reinsurance capital partner or competitive force in the CGT risk-transfer market.
• Tokio Marine HCC: Major stop-loss and medical insurance carrier serving self-insured employers nationwide. Specialty-stop-loss expertise and large broker distribution make it a key competitor OutcomeRx must displace or differentiate against in the CGT niche.
• Everest Re: Major global reinsurer with significant insurance and reinsurance operations across multiple lines. Relevant to OutcomeRx as a capital provider or competitor in specialty health reinsurance, particularly for high-severity blocks like CGT.
• CVS Health (Aetna): Operates Aetna health insurance and Caremark PBM, both of which interact with high-cost specialty therapies including CGT. Comparable to OutcomeRx as a major health services player, though at much larger scale and broader product portfolio.
• RGA (Reinsurance Group of America): Global life and health reinsurer with deep U.S. group benefits reinsurance relationships. Comparable to OutcomeRx's reinsurance posture and could serve as a capacity partner or competitor in the CGT stop-loss space.

Direct peers

• Companion Life Insurance Company: A specialty stop-loss carrier focused on self-funded employer plans, with capabilities for tailored coverage solutions. Directly comparable to OutcomeRx as a specialty stop-loss provider targeting niche employer coverage needs.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks7 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/outcomerx

Revenue estimate

Valuation estimate

Number of profiles

Profiles5 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about OutcomeRx Insurance Management Services