When discussing Gene and Cell therapies the conversation often centers around issues of affordability, equitable access, manufacturing limitations and ultimately the conundrum of creating a sustainable business model. There are many obstacles that face the gene and cell therapy market, but we have made significant progress in the last decade with the approval of a range of therapeutics tackling diverse clinical indications across oncology, neuromuscular disease and inherited blindness. Indications are also expanding as this foundational work can be applied to other tissue regions but with FDA predicting that there will be raft of new products coming to the market in the next year the payor community is steadfast in its belief the requisite frameworks are not in place to accommodate new approvals.