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    • Home Employers Cost Control Strategies Embarc Benefit Protection

    Embarc Benefit Protection

    Protecting customers from the high costs of breakthrough gene therapy drugs.

    Building a new benefits package?

    Making Gene Therapy Drugs More Accessible

    The Embarc Benefit Protection® solution brings together the health services, medical management, and specialty pharmacy expertise of Cigna HealthcareSM offered by Cigna Health and Life Insurance Company, EviCore®, Accredo®, and Express Scripts®. This solution helps shield health plans and customers from the cost of breakthrough gene therapy drugs and helps to ensure access for those who need them.

    Our Embarc Benefit Protection solution includes:

    LUXTURNA®(voretigene neparvovec-rzyl)

    This is the first FDA-approved prescription gene therapy for people with inherited retinal disease at a cost of $850K (both eyes).1

    ZOLGENSMA®(onasemnogene abeparvovec-xioi)2

    A $2.1M gene therapy for children under 2 years old with spinal muscular atrophy a potentially life-threatening condition.3

    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.

    ZYNTEGLO®(betibeglogene autotemcel)4

    Used for a blood disorder known as beta thalassemia in patients who cannot make enough beta-globin and require regular red blood cell transfusions at a cost of $2.8M.5

    For existing Embarc Benefit Protection clients with effective dates of August 1, 2022 or earlier, all members who meet the solution’s clinical and network criteria for ZYNTEGLO will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after August 1, 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.

    SKYSONA®(elivaldogene autotemcel)

    With a cost of $3M,5 this gene therapy is for patients 4-17 years of age with early, active cerebral adrenoleukodystrophy (CALD)—a rare neuro-degenerative disease that can lead to progressive, irreversible loss of neurologic function and death.

    HEMGENIX®(etranacogenedezaparvovec-drlb)6

    A one-time gene therapy drug with a projected cost of $3.5M7 for adults living with hemophilia B who currently use factor IX prophylaxis therapy, or have current or historical life-threatening hemorrhage, or have repeated, serious spontaneous bleeding episodes.

    For existing Embarc Benefit Protection clients with effective dates of March 1, 2023 or earlier, all customers who meet the solution’s clinical and network criteria for HEMGENIX will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after March 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.

    ROCTAVIANTM (valoctocogene roxaparvovec-rvox)8

    A one-time gene therapy drug with a projected cost of $2.9M9 indicated for the treatment of adults with severe hemophilia A.

    For existing Embarc Benefit Protection clients with effective dates of September 1, 2023 or earlier, all customers who meet the solution’s clinical and network criteria for ROCTAVIAN will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after September 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.

    CASGEVYTM (exagamglogene autotemcel)10

    A one-time gene therapy drug with a projected cost of $2.2M11 indicated for the treatment of patients 12 years of age and older with sickle cell disease and for transfusion-dependent beta thalassemia.

    For existing Embarc Benefit Protection clients with effective dates of April 1, 2024 or earlier, all customers who meet the solution’s clinical and network criteria for CASGEVY (for treatment of sickle cell disease) will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after April 1, 2024, 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.

    LYFGENIATM (lovotibeglogene autotemcel)12

    A one-time gene therapy drug with a projected cost of $3.1M13 indicated for the treatment of patients 12 years of age and older with sickle cell disease.

    For existing Embarc Benefit Protection clients with effective dates of April 1, 2024 or earlier, all customers who meet the solution’s clinical and network criteria for LYFGENIA will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after April 1, 2024, 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.

    LENMELDYTM (atidarsagene autotemcel)

    A one-time gene therapy drug with a cost of $4.25M5 indicated for the treatment of children with pre-symptomatic late infantile, pre-symptomatic early juvenile and early symptomatic early juvenile metachromatic leukodystrophy (MLD).

    Did you know?

    By 2032, annual gene therapy sales globally are expected to reach $38.76 billion.14 If health plans cannot afford to cover these drugs, the patients that need them will not have access.

    View Cigna Healthcare Company Names

    1 Drugs.com 2024: price of LUXTURNA

    2 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.

    3 Drugs.com 2023: price of ZOLGENSMA

    4 For existing Embarc Benefit Protection clients with effective dates of August 1, 2022 or earlier, all members who meet the solution’s clinical and network criteria for ZYNTEGLO will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after August 1, 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.

    5 Drugs.com 2024: price of ZYNTELGO, SKYSONA, and LENMELDY

    6 For existing Embarc Benefit Protection clients with effective dates of March 1, 2023 or earlier, all customers who meet the solution’s clinical and network criteria for HEMGENIX will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after March 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.

    7 Drugs.com 2024: price of HEMGENIX

    8 For existing Embarc Benefit Protection clients with effective dates of September 1, 2023 or earlier, all customers who meet the solution’s clinical and network criteria for ROCTAVIAN will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after September 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.

    9 Biopharmadive.com 2023: published price of ROCTAVIAN

    10 For existing Embarc Benefit Protection clients with effective dates of April 1, 2024 or earlier, all customers who meet the solution’s clinical and network criteria for CASGEVY (for treatment of sickle cell disease) will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after April 1, 2024, 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.

    11 Biopharmadive.com 2023: price of CASGEVY

    12 For existing Embarc Benefit Protection clients with effective dates of April 1, 2024 or earlier, all customers who meet the solution’s clinical and network criteria for LYFGENIA will be able to access the therapy through Embarc Benefit Protection. For clients who join Embarc Benefit Protection after April 1, 2024, 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.

    13 Biopharmadive.com 2023: price of LYFGENIA

    14 Precedence Research, Gene Therapy Market Size, Growth, Trends, Report 2023-2032, precedenceresearch.com, accessed January 29, 2024

    LUXTURNA is the registered trademark of Spark Therapeutics, Inc. and ZOLGENSMA is the registered trademark of AveXis, Inc. ZYNTEGLO and SKYSONA are both registered trademarks of bluebird bio, Inc. HEMGENIX is the registered trademark of CSL Behring, L.L.C. ROCTAVIAN is a registered trademark of BioMarin. CASGEVY is a registered trademark of Vertex Pharmaceuticals Inc. LYFGENIA is a registered trademark of bluebird bio, Inc. LENMELDY is a registered trademark of Orchard Therapeutics group.

    Product availability may vary by location and plan type and is subject to change. For costs and details contact a Cigna Healthcare representative.

    Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company (Bloomfield, CT.) (CHLIC), Express Scripts, Inc., or their affiliates. In Utah, all products and services are provided by Cigna Health and Life Insurance Company (Bloomfield, CT). Policy forms: OK – HP-APP-1 et al., OR – HP-POL38 02-13, TN – HP-POL43/HC-CER1V1 et al. (CHLIC); GSA-COVER, et al. (CHC-TN).

    © 2024 Cigna Healthcare.

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    Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of The Cigna Group Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT). The Cigna Healthcare name, logo, and other Cigna Healthcare marks are owned by The Cigna Group Intellectual Property, Inc.

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