Embarc Benefit Protection℠ – Affordability and access that can literally save lives

Life-changing and potentially curative gene therapy medicines, which are used to treat patients with a genetic disease, offer great promise for patients and their families. However, these medicines can’t help the people who can’t pay for them and payers who can’t cover them. Health plans and employers need protection from the price shock of suddenly paying for million-dollar therapies. And, they need help making these potentially curative drugs accessible to patients who need them.

Expected cost of gene therapies in the U.S. by 2024¹

gene and cell therapies are anticipated to receive FDA approval by 2025²

Meeting in conference room between two people. — The return can be astounding

For example, for 99¢ per member, per month, an employer with 1,000 lives would have a monthly payment of $990. If one employee needed gene therapy, the employer could now ensure access to that therapy while paying virtually nothing against the cost of a $2M lightning-strike claim.

Embarc Benefit Protection

This novel solution addresses the critical need facing everyone from payers to patients by delivering better care, affordability and access. As the industry’s first solution to build a new pathway to pay for the coming wave of expensive, potentially curative therapies, Embarc Benefit Protection will change the future of health care.

Shielding payers

Now, plans and employers have an option specifically built for one-time, potentially curative therapies. Embarc’s protection for the “million-dollar lightning strike” is as vital as any other financial protection a business can buy.

Helping people

Patients will have no out-of-pocket payments for the covered therapies and will receive personalized and expert care to assist them through their health journey.

Embarc graphic — How it works

Embarc Benefit Protection brings together the health services, medical benefit management and specialty pharmacy expertise of Express Scripts, eviCore, Accredo and CuraScriptSD to make breakthrough medicines more affordable and ensure access for those who need it.

Phase one

We will include Luxturna™ (voretigene neparvovec-rzyl), the first FDA-approved prescription gene therapy for people with inherited retinal disease, and Zolgensma^® (onasemnogene abeparvovec-xioi), a gene therapy for children under 2 years old with spinal muscular atrophy, in the Embarc Benefit Protection solution. As new gene and cell therapies are approved by the FDA, we will evaluate for future inclusion.

Together, the path is clear

Like our Patient Assurance Program℠ and Digital Health Formulary, Embarc Benefit Protection demonstrates what our combined company can do for our clients and patients to deliver on the promise of modern medicine. Our goal is to provide coverage to as many people as possible, as soon as possible, promoting access to life-altering, high-cost gene therapies.

Additional information on enrollment will be available in February 2020.