Integrated gene and cell therapy services
Evernorth Health Services is committed to simplifying the coordination of gene and cell therapy care and coverage for plans and members.
Helping you succeed today and plan for tomorrow
As more gene and cell therapy products move toward approval, an estimated 340,000 patients are expected to receive one of these treatments by 2030.1 But without strategic planning and collaboration, even the most promising treatments may remain out of reach for the people who need them the most.
Making these highly targeted treatments more accessible and affordable requires a combination of cost-sharing innovations, sustainable coverage models and strong partnerships with specialty pharmacies.
Advancing access through collaborative solutions
At Evernorth, our offerings are designed to help ease the journey to connecting those with rare conditions to life-changing drugs — from access, to distribution, to utilization. Our gene and cell therapy solutions include:
Comprehensive cost management
Clinical support and therapy education
Customized, end-to-end distribution services
Coordinated access and care assistance
Embarc Benefit Protection
An innovative approach for affordable access
The cost of gene therapies ranges from hundreds of thousands of dollars to $4.25 million,1 creating substantial financial risk for health plans and threatening access for members. Even with stop-loss coverage, there are often high deductibles that need to be met and price increases that are applied to premiums when claims are filed.
Embarc Benefit Protection offers patients with genetic conditions simple, affordable and predictable access to breakthrough gene therapy treatments while shielding plans from bearing the high cost of these claims
Embarc Benefit Protection offers benefits and protections not included with stop-loss coverage:
No up-front payments that would require reimbursement
Cost predictability via a set per-member-per-month fee
Surplus payout eligibility—even if claims are incurred throughout the year
Enhancing access to gene and cell therapies, together
The fast-evolving gene and cell therapy landscape brings new hope. Evernorth helps health plans prepare with strategies that meet member needs while managing costs.
Source
- Drug Discovery Trends, 2024. “With prices topping $4 million, high stakes define cell and gene therapy landscape”.
* As long as applicable deductibles are met
Evernorth Therapy Link: Gene and Cell
Identifying patients and improving outcomes
Ensuring the right individuals benefit from the right gene and cell therapies at the right time is one of health care’s most complex challenges. Evernorth Therapy Link unites capabilities and expertise across our entire organization to connect health plans, providers and manufacturers and address key barriers—affordability, accessibility, logistics and administration—to connecting those with rare conditions to potentially curative treatments.
Evernorth Therapy Link offers:
Access to high-cost, potentially life-changing gene therapies
No out-of-pocket costs for included therapies and related patient care*
End-to-end case management, guiding patients through every step of their treatment journey
Utilization management that ensures a managed cost of care, while providing a seamless member experience
Accredo Specialty Pharmacy
An ecosystem of clinical and educational patient resources
Accredo Specialty Pharmacy serves patients with complex and chronic health conditions, delivering a level of expertise and care that is unmatched in this space. Our specialty-trained team members are dedicated to your members’ care journeys and capable of providing holistic support specific to even the most complex conditions.
Accredo Specialty Pharmacy offers:
500+ specialty trained pharmacists available to answer questions over the phone
600+ specialty trained infusion nurses who provide home visits to patients
Therapy management programs and training on medication administration
Gail Bridges, PharmD
Sr. Director and Clinical Practice Lead, Accredo Specialty Pharmacy
CuraScript SD by Evernorth
Customized, end-to-end distribution services
CuraScript SD by Evernorth equips providers with comprehensive specialty distribution and support services that are aligned with payer goals and tailored to the complex gene and cell therapy landscape.
CuraScript SD by Evernorth offers:
Specialized handling and distribution expertise, ensuring timely delivery of gene and cell therapies
Complete contract management services, including outcomes-based agreements and pricing arrangements
Dedicated inventory management support, including precise tracking to help reduce waste and ensure availability
Streamlined revenue management solutions, including utilization reporting, volume aggregation, simplified billing statements and flex payment programs
