It was the first broadly marketed solution to specifically target the administration, coverage, financing, and patient support of high-cost gene therapies. For each solution outlined below let’s try to understand 3 primary elements: breadth of coverage and approach to new entrants (coverage) ability to negotiate and financial risk transfer versus amortization (financing) and patient support model and use of outcomes-based contracting (outcomes).Įvernorth announced its Embarc Benefit Protection in late 2019. But alternative funding models were recently introduced that were specifically designed to address this growing market need. To date, most plan sponsors and self-funded employers have relied on their stop-loss policies to cover high-cost gene therapies. From members to health plans, pharmacy benefit managers (PBMs), plan sponsors, and reinsurers, the entire industry is grappling with how to cover, fund, and ensure the best outcomes for these new treatments. These extremes have led to some recent innovations outside the therapies themselves, specifically related to financing and payment models.

A new therapy might save a loved one, while simultaneously bankrupting a household or causing other significant financial strain. These therapies carry life-preserving and life-saving benefits, profoundly affecting recipients and their families. Gene therapies cure or treat a condition by inactivating, introducing, or replacing a modified or new gene.

Gene binder insurance