High cost health technologies, mostly targeting rare diseases and genetic disorders, are becoming a growing source of concern to public and private payers due to their potentially disruptive front-loaded budget impact. Current funding mechanisms, structured to cover incremental costs usually required to treat patients with chronic conditions, will have to be re-designed as highly effective curative therapies are disrupting the distribution of treatment cost with the long-term realisation of clinical benefits to patients. Pressure to make these treatments available and accessible to patients on the basis of effectiveness (i.e. cure) and future medical cost offsets was observed already with Hepatitis C drugs. Rapid advances in gene therapies and promising clinical trial results are likely to further increase the number of patients eligible for these high cost treatments. Sponsored by the Society of Actuaries (SOA) - Health Section, this work presents a framework for evaluating alternative reimbursement approaches, with considerations specific to public and private payer perspectives in the US and UK. Various financing and insurance-like models are explored, ultimately highlighting the strengths and weaknesses of each of these approaches to the type of health technologies at hand, and identifying areas where traditional insurance risk principles may break down. Illustrative scenarios using real-world data explore the applicability of these alternative reimbursement models to selected disease areas and therapies, and demonstrate the magnitude of the financial risks to payers. While traditional actuarial approaches are normally used to quantify the potential financial risk to payers of introducing novel technologies, health economic evaluations tend to focus on predicting long-term costs and outcomes of new treatments. Therefore, managing the financial uncertainty of high cost technologies while maximising patient clinical benefits is an area where both disciplines can leverage each other to develop effective and durable alternative reimbursement models.