Embarc Benefit Protection®
Ensuring access to breakthrough gene therapy drugs while protecting plans and members from high costs.
Affordable access to gene therapies
At Evernorth® Health Services, we are advocates for better health. We understand the immense burden that high-cost gene therapies often place on your plan and the members you serve.
The cost of these revolutionary therapies threatens access to those who may benefit the most. For protection beyond stop-loss coverage, plans need a solution that shields them from high-cost gene therapy claims.
Embarc Benefit Protection
We’re aligned, first and always with the people who need care the most, which is why we created Embarc Benefit Protection, a comprehensive program that offers patients with genetic conditions simple, affordable and predictable access to life-changing and potentially curative treatments.
A pathway for affordable access to expensive treatments
Our comprehensive gene therapy program connects members with best-in-class care using innovative models that drive affordability.
Together with participating plans, we can:
+ Improve access to potentially life-changing therapies
+ Connect members with best-in-class providers
+ Shield plans from price shock of expensive therapies
+ Provide additional value through an annual surplus refund
+ Create cost predictability via a set per member per month (PMPM) price
Embarc Benefit Protection offers added protection with benefits that stop-loss coverage doesn’t include, such as:
How Embarc Benefit Protection works
Once plans join with a PMPM fee, when a member needs a drug that's included in Embarc Benefit Protection, their provider submits a prior authorization request for the gene therapy.
Upon approval, Embarc's case management team will arrange for the provision of the gene therapy drug and ensures the member gets the necessary treatment with no out-of-pocket cost for the therapy.*
The evolution of Embarc Benefit Protection
As the market for gene therapies evolves, we will continue to innovate and find new ways to effectively meet plans and member needs and are excited to announce enhancements to Embarc Benefit Protection effective January 1, 2026:
Broadened access and program portability
that enable plans to join and continue using Embarc Benefit Protection independent of their medical carrier—giving them more control of their gene therapy benefits.
Expanded protection
that combines the cost of the gene therapy with other ancillary costs related to the member’s care and gene therapy treatment.
End-to-end case management
that supports members throughout their gene therapy journey.
Utilization management
that ensures a managed cost of care, while providing a seamless member experience.
Even as the cost of these therapies continue to rise—ranging from $913K to $4.25M2— Embarc Benefit Protection guards your plan from the high cost of gene therapy.
Proactive management strategy for gene therapy protection
As we continue to evaluate new gene therapies for inclusion in Embarc Benefit Protection, we remain focused on providing payers and their members with appropriate clinical and financial management for gene therapies as they come to market.
Sources
- BioSpace, “U.S. gene therapy market Size to Hit USD 18.50 Billion by 2033”, 2025.
- $913K: Spark Therapeutics Inc. 2025 price of LUXTURNA® therapy in US., $4.25M: BioSpace 2024: published price of LENMELDYTM from the manufacturer
*Members with an HSA must have met the applicable minimum deductible required for a high deductible health plan