Gene and cell therapies represent a significant advancement in medicine, involving the modification or manipulation of genes to treat or prevent diseases, and the treatment of a disease through transplantation of healthy cells to replace damaged or diseased ones. However, the high costs and complex management of these therapies pose substantial challenges for patients, payers, plan sponsors and health care systems alike.
The high cost of these treatments, which can range from $900,000 to over $4 million, is offset by the potential savings from avoiding the lifelong expenses associated with comprehensive disease management. Researchers have identified approximately 10,000 diseases linked to genetic errors, many that currently lack effective treatments. With over 4,400 gene and cellular therapies in development and more than 1,500 clinical trials underway, the patient populations for these therapies are expected to grow significantly in the next decade as treatments for more common conditions emerge. Researchers estimate that the number of U.S.-based patients treated with gene therapy or stem cell therapy will grow to over 340,000 annually by 2030 – 28 times more patients than those treated in 2020. Launching these therapies and ensuring their clinical efficacy is complex, requiring precision in identifying suitable patients, managing payer risk and ensuring access.
Evernorth Therapy Link uses pharmacy and medical claims data to help spot patients who may benefit from gene or cell therapies, making it easier for manufacturers to launch these treatments and for patients to get timely, appropriate care.
“Evernorth Therapy Link builds on our leadership in making gene and cell therapies more accessible and affordable,” said Mark Jacob, senior director of product strategy, Accredo Specialty Pharmacy. “This new solution is designed to identify patients who can benefit most from these treatments and support them throughout their journey, as well as help manage costs for both patients and payers.”
By bringing together the expertise of Accredo Specialty Pharmacy, CuraScript SD by Evernorth, Express Scripts Pharmacy Benefit Services, and Forsyth Health, Evernorth is tackling the complexities of gene and cell therapies with four key strategies:
1. Data and insights
Early identification of clinically appropriate candidates is key – and it requires a data-driven approach. Evernorth Therapy Link utilizes medical and pharmacy data to proactively identify potential patients and referral opportunities. Additionally, it provides detailed reporting and clinical insights to pharmaceutical partners from research and development through launch and beyond.
2. Payer protection
Evernorth’s gene therapy program, Embarc Benefit Protection, shields plans from high-cost gene therapy treatments and related patient care claims. For a predictable per-member-per-month fee, this program helps payers ensure that their members have simple and affordable access to life-changing therapies and support throughout treatment.
3. Specialty distribution
CuraScript SD by Evernorth offers customizable distribution strategies tailored to the specific disease state and patient population – ensuring complex deliveries are handled with care. Additionally, it provides flexible payment terms and expert logistics management, helping to manage financial burdens and ensure timely delivery.
4. Clinical expertise
Accredo Specialty Pharmacy’s team of specialty-trained clinicians deliver individualized support, educating and guiding patients and their caregivers through the therapy journey. This ensures continuity of care and improved health outcomes.
“By leveraging the deep expertise across our organization, we’re addressing the challenges of these complex therapies, ensuring the long-term viability of treatments,” said Jacob. “As these innovative treatments become more widely available, our focus is on making sure patients get the care that’s clinically appropriate and affordable for them and contributes to a healthier health care system overall.”
With the launch of Evernorth Therapy Link, our organization is uniquely positioned to lead the future of this rapidly evolving field. By integrating deep clinical expertise, robust data and insights, payer protection strategies and specialized distribution capabilities, we are delivering a comprehensive, end-to-end solution that addresses the most pressing challenges in gene and cell therapy. Our commitment to improving access, affordability and outcomes ensures that patients, providers and partners alike can navigate this complex landscape with confidence – making Evernorth a trusted partner in advancing the promise of these life-changing therapies.
