Embarc Benefit Protection is the first solution of its kind to build a new pathway for payers to afford the coming wave of expensive, potentially curative gene therapy medications.
- Embarc Benefit Protection fills a critical unmet need to protect payers, and is available to insurers, HMOs, TPAs, and self-funded employer plans through their medical carrier, so these potentially life-altering cures will not be out of reach for any patients* covered by a plan with the Embarc Benefit Protection solution.
- Embarc is available through eviCore, an Express Scripts company, who will arrange affordable access to high-cost, breakthrough therapies through a carefully selected network of specialty care pharmacies, including Accredo specialty pharmacy, and CuraScript SD.
Key components of Embarc Benefit Protection
Embarc Benefit Protection will initially cover Luxturna®, the first FDA-approved prescription gene therapy for patients with inherited retinal disease, and Zolgensma®, a gene therapy for children younger than 2 years old with spinal muscular atrophy.
- For $0.99 per member, per month, Embarc Benefit Protection creates member access to high-cost, potentially curative therapies, while ensuring cost predictability for payers.
- Embarc Benefit Protection was initially available via eviCore contracting directly with health plans and is now also available directly to employers via eviCore, or via eviCore contracting directly with their health plan.
- As new gene and cell therapies are approved by the FDA, we will continue to assess for future inclusion on an ongoing basis.
For a more detailed look at the solution and its benefits, please click here.
*With respect to Zolgensma, the solution applies only to children born after the Embarc Benefit Protection solution is implemented for their group health plan. Children born before the implementation date will have coverage under their medical plan. Plan deductible, co-insurance and co-pays will apply to the gene therapy product and related administration costs.
