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 need them when patients and clients alike aren’t prepared to pay for 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 more affordable and accessible to patients who need them.
Evernorth Embarc Benefit Protection®
What is Evernorth?
Embarc Benefit Protection is just one of the life-saving solutions from Evernorth, health services built on the recognition that health makes progress possible. Working together with health plans, employers, and government programs, we're solving the problems others don’t, won’t, or can’t.
Expected cost of gene therapies in the U.S. by 20261
gene and cell therapies are anticipated to receive FDA approval by 20252
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. Having Embarc Benefit Protection in place 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.
How it works
Embarc Benefit Protection brings together the health services, medical benefit management and specialty pharmacy expertise of eviCore, Accredo, CuraScript SD, and Express Scripts, to make breakthrough medicines more affordable and ensure access for those who need it.
The solution includes:
- LUXTURNA® (voretigene neparvovec-rzyl): The first FDA-approved prescription gene therapy for people with inherited retinal disease
- ZOLGENSMA® (onasemnogene abeparvovec-xioi)3: A gene therapy for children under 2 years old with spinal muscular atrophy
- ZYNTEGLO® (betibeglogene automemcel)4: Used for a blood disorder known as beta thalassemia in patients who cannot make enough beta-globin and require regular blood transfusions
- SKYSONA® (elivaldogene autotemcel): To slow the progression of neurologic dysfunction in boys 4-17 years of age with early, active cerebral adrenoleukodystrophy (CALD)
- Additional therapies may be added in the future
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 help make these life-changing, high-cost gene therapies accessible to the people who need them – as soon as possible.
Build a solution for high-cost therapies
Create financial protection
Leverage specialized pharmacy dispensing and distribution
Connect patients with best-in-class providers
Supports patients on their journey
Explore related insights
1 EvaluatePharma
2 www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-and-peter-marks-md-phd-director-center-biologics
3 The financial protection against the high cost of Zolgensma applies only to children born after the Embarc Benefit Protection solution is effective for their group.
4 For existing Embarc Benefit Protection clients with effective dates of 08/01/2022 or earlier, all members who meet the solution’s clinical and network criteria for ZYNTEGLO will be able to access the drug through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after 08/01/2022, the financial protection extends only to members who join the underlying medical coverage 30 days after the client is effective in Embarc Benefit Protection.
* If a member is enrolled in a high deductible health plan and has not met their deductible for that plan year, there may be out-of-pocket costs associated
2 www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-and-peter-marks-md-phd-director-center-biologics
3 The financial protection against the high cost of Zolgensma applies only to children born after the Embarc Benefit Protection solution is effective for their group.
4 For existing Embarc Benefit Protection clients with effective dates of 08/01/2022 or earlier, all members who meet the solution’s clinical and network criteria for ZYNTEGLO will be able to access the drug through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after 08/01/2022, the financial protection extends only to members who join the underlying medical coverage 30 days after the client is effective in Embarc Benefit Protection.
* If a member is enrolled in a high deductible health plan and has not met their deductible for that plan year, there may be out-of-pocket costs associated