Cell and gene therapies are among the most remarkable – and costly – treatments in health care today. They have the potential to cure diseases once thought to be incurable, such as cancer, muscular dystrophies, and hemophilia. However, these benefits can come with an extremely high price tag.

That’s why Berkley Accident and Health offers a solution to manage cell and gene therapy. We have selected Emerging Therapy Solutions® (ETS) as a best-in-class provider to help our clients navigate the complexity and cost of these treatments. ETS can provide education, pricing discounts, contract negotiation, predictive modeling, and access to services and suppliers.

What is Gene Therapy?

DNA is the blueprint, or genetic code, that lives inside each cell. Occasionally one of these genes mutates and malfunctions, leading to a genetic condition or disorder. Gene therapy is a treatment designed to fix the genetic code by introducing a functioning copy of the misfiring gene. It works by introducing a healthy copy of the gene into the patient’s body that alters the faulty DNA, restoring its proper function.

Watch FDA Video

Learn more about these gene therapy treatments:

• Zolgesma (Employer Stop Loss clients) 
• Zolgensma (Managed Care clients) 
• Luxterna 

How Can ETS and Berkley Accident and Health Help?

ETS can help Berkley Accident and Health’s clients by:

1. Evaluating risk
   ETS monitors the clinical trial pipeline for upcoming cell and gene therapies and can provide education and custom exposure forecasts to estimate an organization’s financial risk.
   
2. Positively impacting cost when a claim occurs
   When a patient is referred for cell or gene therapy, ETS can provide options on where to receive care. Its Programs of Excellence identify health care facilities that deliver quality, cost-effective care. And finally, ETS has pricing relationships that can make costs more predictable and favorable.
   
3. Managing the details throughout the claim
   Once a patient receives cell or gene therapy, ETS will review and reprice the relevant claims.

Measurable Results

ETS has experience with cell and gene therapies, including two of the newest treatments, Zolgensma and Yescarta:

When you work with ETS, potential cell and gene therapy savings opportunities could include savings from:

• Network and contracting
• Claim reviews and payment accuracy
• Manufacturer’s discounts
• Travel and ancillary benefits

Berkley Accident and Health is a risk management leader and provider of innovative Stop Loss and Managed Care protection for organizations. We offer strong financial protection and exceptional value-added services, such as our Berkley Edge program that reviews 100% of claims for 100% of clients for cost-containment opportunities.

Learn More

To learn more, contact your Berkley Accident and Health representative.

Berkley Accident and Health assumes no responsibility or liability for any advice or resources provided by ETS. ETS makes no representation, warranty, or commitment of any kind regarding the outcome of any care provided or the coverage or payment for the same.  

Insurance coverage is underwritten by Berkley Life and Health Insurance Company and/or StarNet Insurance Company, both member companies of W. R. Berkley Corporation and both rated A+ (Superior) by A.M. Best. Not all products and services may be available in all jurisdictions, and the coverage provided is subject to the actual terms and conditions of the policies issued. Payment of claims under any insurance policy issued will only be made in full compliance with all United States economic or trade and sanction laws or regulation, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“OFAC”).

BAH AD 2021-25    3/21