OBJECTIVES: To obtain payer feedback regarding their readiness to adopt new gene therapies and the need for specific new financial models. Gene therapies, while innovative and potentially curative, are expensive treatments with uncertain durability. Current financing and reimbursement mechanisms may not be sustainable as the aggregate cost of treatments mounts. METHODS: Sixty-minute telephone interviews were conducted with 23 financial decision makers from 15 United States (US) payers between August and September 2017. Interviewees from various payer segments, including commercial plans, self-insured employers, Medicare, Medicaid, Integrated Delivery Networks (IDN), and reinsurers were invited to participate. Interviewees were offered a two-page pre-read and study protocol, and voluntarily agreed to participate without financial incentive. RESULTS: All payer segments were represented with a minimum of 3 interviews per segment. Nearly two-thirds of interviewees held financial positions, while approximately one-third were clinicians. Plan size ranged from 4,000 lives to over 4 million lives. One-third (n=5) recently became aware of new gene therapies or were made aware through the interview process, 40% (n=6) described watchful waiting, while 26.7% (n=4) were engaged in active management. New payment models, specifically, performance-based payments and risk-pooling, were supported by 47% (n=7) of payers, while the current payment model was supported by 53% (n=8). Major challenges include uncertainty related to utilization, cost, and duration of cure. Payers cited regulation, plan turn-over, and ability to track long-term outcomes measures as barriers to implementation of new models. CONCLUSIONS: Access to new gene therapies may be impacted by payer ability to adsorb the cost of coverage. Variation exists in awareness of new gene therapies and level of incorporation of new costs into plan coverage. The sustainability of the current financing mechanisms varies by payer segment, profitability, and size. Payers are open to innovative financing models that improve financial predictability and reward clinical performance.