What employers need to know
- 13 available gene therapies, including four newly added treatments.
- Predictable costs through a fixed per-member, per-month fee.
- Protection from multimillion-dollar gene therapy claims.
- More than $197 million in value delivered to employer plans since 2020.
- Clinical support, care coordination, and personalized guidance for employees and families throughout treatment.
As more high-cost gene therapies enter the market, employers face growing challenges balancing access to innovative treatments with affordability and financial predictability. Evernorth’s Embarc Benefit Protection program helps address these challenges by protecting benefit plans from the financial impact of certain gene therapies while supporting access to care through clinical expertise, care coordination, and personalized support for patients and families.
Gene therapies target the underlying genetic causes of disease and can significantly reduce symptoms or alter the course of serious conditions that historically had few or no effective treatment options. As the gene therapy market continues to expand, employers face increasing exposure to treatments that can cost millions of dollars.
To help employers navigate this rapidly evolving landscape, Evernorth has expanded Embarc by adding four new gene therapies to bring the program’s total to 13 available treatments.
The newly added one-time therapies include:
- Elevidys, a gene therapy for Duchenne muscular dystrophy.
- Itvisma, a gene replacement therapy for spinal muscular atrophy.
- Encelto, a treatment for MacTel, a rare neurodegenerative retinal disease.
- Waskyra, a gene therapy for Wiskott-Aldrich syndrome.
Through Embarc, employers pay a predictable per-member, per-month fee that helps protect their benefit plans from the financial impact of the 13 included gene therapies while supporting access to these innovative treatments for eligible employees and their families, who incur no out-of-pocket costs*. Nearly 8 million plan members are eligible for Embarc today.
Evernorth has also expanded access for all protected therapies by removing previous contractual limitations, making these treatments available to newly participating groups and children born before their parent’s group joined the program.
Why employers need protection from rising gene therapy costs
The need for solutions like Embarc continues to grow as the gene therapy pipeline expands. With more than 2,100 gene therapies currently in development and an estimated 30 to 50 new approvals expected by 2030, employers are facing growing exposure to potentially high-cost treatments.
Several of the therapies now included in Embarc address conditions that historically had few or no effective treatment options. By expanding access to new therapies as they become available, Embarc helps employers manage the financial risk without absorbing the full impact of an unexpected multimillion-dollar claim.
Each therapy is evaluated based on clinical evidence, with inclusion decisions informed by the latest data on safety, effectiveness, and long-term benefit. For example, when Elevidys was first approved in 2023, the available data did not support including it. As more recent evidence demonstrated meaningful clinical benefit, Evernorth updated its clinical recommendations and added it to Embarc.
This evidence-based approach helps employers navigate a rapidly evolving gene therapy landscape with greater confidence, knowing new treatments are being carefully evaluated for clinical value and patient benefit.
How Embarc Benefit Protection helps protect employers from high-cost claims
For one employer with approximately 2,950 enrolled health plan members, Embarc delivered nearly $4.2 million in savings when an individual with hemophilia B received Hemgenix, a gene therapy that can cost approximately $3.5 million. The savings included both treatment and administrative costs, while the member received the therapy with no out-of-pocket cost.
This case illustrates how Embarc helps employers manage the financial impact of high-cost gene therapies while supporting access to care. Since its launch in 2020, Embarc has delivered more than $197 million in value to participating employer plans.
Gene therapies included in Embarc Benefit Protection
As of July 2026, Embarc provides access for gene therapies that treat a range of rare and serious conditions.
| Therapy | Treats | |
|---|---|---|
| 1 | Casgevy | Beta thalassemia and sickle cell disease |
| 2 | Elevidys | Duchenne muscular dystrophy |
| 3 | Encelto | MacTel (idiopathic macular telangiectasia type 2) |
| 4 | Hemgenix | Hemophilia B |
| 5 | Itvisma | Spinal muscular atrophy (SMA) |
| 6 | Kebilidi | Aromatic L-amino acid decarboxylase (AADC) deficiency |
| 7 | Lenmeldy | Metachromatic leukodystrophy (MLD) |
| 8 | Luxturna | Inherited retinal dystrophy |
| 9 | Lyfgenia | Sickle cell disease |
| 10 | Skysona | Cerebral adrenoleukodystrophy (CALD) |
| 11 | Waskyra | Wiskott-Aldrich syndrome |
| 12 | Zolgensma | Spinal muscular atrophy (SMA) |
| 13 | Zynteglo | Beta thalassemia |
How the Embarc Benefit Protection program supports patients receiving gene therapy
Gene therapy treatment often requires coordination among specialists, treatment centers, caregivers, travel arrangements, and follow-up care. Embarc helps simplify that process through utilization management, case management, and care coordination.
For employers with Cigna Healthcare medical coverage, these services are integrated into the Cigna gene therapy benefit and clinical program. For employers with another medical administrator, Embarc provides these services directly, helping guide patients through the treatment process.
In either case, expert clinical teams help coordinate care, guide patients and families through each step of the treatment journey, and facilitate communication among providers, treatment centers, and caregivers to create a more seamless care experience. This allows patients and families to focus on their health rather than the cost and complexities of their care.
Embarc case managers also support patients’ whole-person needs, helping them navigate not only their gene therapy but also their overall health and wellness.
“Gene therapy products are life-altering treatments that can be extremely high cost. For those customers that are eligible for Embarc, it has reduced financial barriers for both the customer and the client. I have seen Embarc make a meaningful difference by enabling customers to access the care they need and move forward with greater confidence throughout their treatment as well as life after gene therapy.”
— Megan, Embarc case manager
By bringing together financial protection, utilization management, and case management, Embarc can help employers address the financial, clinical, and operational challenges associated with gene therapy.
Common questions about Embarc Benefit Protection
How Embarc Benefit Protection will continue to evolve
As gene therapy innovation continues to accelerate, Evernorth will continue evaluating new treatments for potential inclusion in Embarc. Through this evidence-based approach, the program will continue to help employers manage the evolving gene therapy landscape while supporting access to care for eligible patients and families.
*Members with an HSA must have met the applicable minimum deductible required for a high-deductible health plan.
Evernorth Embarc Benefit Protection is a comprehensive program that offers patients with genetic conditions simple, affordable and predictable access to life-changing and potentially curative treatments.
