Leading the Model for Change: Making Gene Therapy Treatment Affordable and Accessible
Gene therapy is an emerging technique that uses genes to treat or prevent diseases like inherited retinal disease or spinal muscular atrophy. An estimated 30 million people in the U.S. suffer from these rare conditions and could benefit from gene therapy to treat and cure their conditions. However, the costs for the therapies are exceedingly high, ranging up to $2.1 million per patient. Due to the costs, there are concerns about patient access to these therapies, and the likelihood that employers and health insurance plans will be able to provide coverage for these therapies.
Lauren Masterson-Rodriguez’s MPH’20 practicum work centered on running an industry-first project called Embarc Benefit ProtectionSM to help make gene therapy accessible and affordable for both patients and insurance plans.
Announced last fall, Embarc Benefit Protection is designed to allow employers and plans to pay a low, per-member-per-month fee to be part of gene therapy network. When a member of their benefit plan needs a gene therapy that is part of the network, they can access without any out-of-pocket payments related to the cost of the medicine.
There are two gene therapies that are part of the network currently:
- Luxturna™, the first FDA-approved prescription gene therapy for people with inherited retinal disease, and
- Zolgensma®, a gene therapy for children under two years old with spinal muscular atrophy.
Additionally, patients and their families will receive personalized and expert care to assist them through their health journey.
The path to the creation of Embarc Benefit Protection was managed by Masterson-Rodriguez who works at Ascent Health Services, a pharmaceutical group purchasing organization that is part of Express Scripts. Cigna Corporation is Express Scripts parent company.
Steve Miller, MD, executive vice president and chief clinical officer for Cigna, placed Masterson-Rodriguez in charge of managing Embarc Benefit Protection’s design, seeing that it would be an ideal fit for her practicum project.
“Dr. Miller has been a mentor and a champion for me as I navigate my career at Cigna and Express Scripts,” says Masterson-Rodriguez. “As a result of this project, I have been able to make new connections throughout the organization in areas that I would not have been exposed to otherwise.”
Masterson-Rodriguez created the Embarc Benefit Protection project framework. She worked closely with the leadership teams at Cigna and Express Scripts, identifying and working with finance, underwriting, clinical, legal, marketing, and sales departments, to create a payment model for therapies that is like no other in the industry.
“The health care system and payment models in place today are structured to support chronic conditions," says Masterson-Rodriguez. "The system is not designed to pay for curative therapies like gene therapy. Embarc Benefit Protection addresses a critical need facing the entire health care system, delivering better care, affordability and access.”
I recently took on a new role at Cigna as Vice President, Pharma Contracting and Strategy in part because of the practicum experience through the MPH program. I am thankful to the Dartmouth faculty and staff for investing time in helping me evolve my practicum work into new professional opportunities.
POSTED 2/10/2020 AT 12:28 PM IN #practicum
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