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Embarc Benefit Protection Surplus
For 2025, utilization was lower than projected, resulting in a client surplus return.
Embarc Benefit Protection® surplus
The shared surplus is generated across Embarc’s enrolled book of business, helping maintain transparency and ensuring PMPM fees remain aligned with actual gene therapy utilization.
What drove the 2025 surplus:
Embarc pricing assumed utilization of 10 high‑cost FDA‑approved gene therapies.
Actual utilization was lower, primarily due to the extensive preparation required for stem‑cell‑based treatments.
While there was a significant increase in patients pursuing sickle cell gene therapy in 2025, most treatments are expected to occur in 2026 or later.
What’s next for Embarc
The gene therapy pipeline continues to expand.
Two to three additional FDA‑approved gene therapies are anticipated for inclusion effective July 1, 2026.
Embarc’s PMPM fee remains predictable and not tied to individual client claims experience, though it may adjust as therapies, pricing, or utilization change.
