EVERNORTH EMBARC BENEFIT PROTECTION®
Ensuring access to breakthrough gene therapy drugs while offering protection from high costs.
Gene Therapies can change patients' lives, but are cost-prohibitive for most
Life-changing and potentially curative gene therapy medicines, which are used to treat patients with a genetic disease, offer great promise for patients and their families.
20 gene and cell therapies are anticipated to receive FDA approval in the next few years.1
However, these medicines can’t help the people who need them when patients and clients alike aren’t prepared to pay for them. Health plans and employers need protection from the price shock of suddenly paying for million-dollar therapies. And, they need help making these potentially curative drugs more affordable and accessible to patients who need them.
1. FDA News Events, 2019
The Greatest Barrier to Care
Cost per patient can range from $850K to $3.5M2,3
2. NBC News, 2018
3. Precedence Research
The median U.S. household income4
4. National Bureau of Economic, 2021
Expected cost of gene therapies in the U.S. in the next few years3
Embarc Benefit Protection®
Bringing life-changing gene therapies to patients.
This novel solution addresses the critical need facing everyone from payers to patients by delivering better care, affordability, and access. As the industry's first solution to build a new pathway to pay for the coming wave of expensive, potentially curative therapies, Evernorth Embarc Benefit Protection will change the future of health care.
Delivering better care, affordability, and access with Embarc Benefit Protection®
* If a member is enrolled in a high deductible health plan and has not met their deductible for that plan year, there may be out-of-pocket costs associated.
Proactive management strategy for gene therapy protection
LUXTURNA® (voretigene neparvovec-rzyl): The first FDA-approved prescription gene therapy for people with inherited retinal disease
ZOLGENSMA® (onasemnogene abeparvovec-xioi): A gene therapy for children under 2 years old with spinal muscular atrophy5
ZYNTEGLO® (betibeglogene automemcel): Used for a blood disorder known as beta thalassemia in patients who cannot make enough beta-globin and require regular blood transfusions6
SKYSONA® (elivaldogene autotemcel): To slow the progression of neurologic dysfunction in boys 4-17 years of age with early, active cerebral adrenoleukodystrophy (CALD)
HEMGENIX® (etranacogene dezaparvovec-drlb): For the treatment of adults with Hemophilia B (congenital Factor IX deficiency) who currently use Factor IX prophylaxis therapy, or have current or historical life-threatening hemorrhage, or have repeated, serious spontaneous bleeding episodes7
ROCTAVIAN™ (valoctocogene roxaparvovec-rvox): A gene therapy from BioMarin for the treatment of adults with severe hemophilia A, with factor VIII activity less than 1 IU/dL, who are without pre-existing antibodies to adeno-associated virus serotype 5 (detected by an FDA-approved test.)8
5. The financial protection against the high cost of ZOLGENSMA applies only to children born after the Embarc Benefit Protection solution is effective for their group health plan.
6. For existing Embarc Benefit Protection clients with effective dates of 08/01/2022 or earlier, all customers who meet the solution’s clinical and network criteria for ZYNTEGLO will be able to access the drug through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after 08/01/2022, the financial protection extends only to customers who enroll in the underlying medical coverage 30 days or more after the client is effective in Embarc Benefit Protection.
7. For existing Embarc Benefit Protection clients with effective dates of 03/01/2023 or earlier, all customers who meet the solution’s clinical and network criteria for HEMGENIX will be able to access the drug through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after 03/01/2023, the financial protection extends only to customers who enroll in the underlying medical coverage 30 days or more after the client is effective in Embarc Benefit Protection.
8. For existing Embarc Benefit Protection clients with effective dates of 9/1/2023, or earlier, all customers who meet the solution’s clinical and network criteria for ROCTAVIAN will be able to access the drug through Embarc Benefit Protection. For clients that join Embarc Benefit Protection after 9/1/2023, the financial protection extends only to customers who join the underlying medical coverage 30 days or more after the client is effective in Embarc Benefit Protection.
How Embarc Benefit Protection® delivers return on investment
