Hundreds of life-saving, bank-breaking therapiesare coming.
Only one company can help you be protected and prepared.
THE CHALLENGE
Don’t wait until it’s too late.
As more cell and gene therapies (CGT) move into the mainstream, their prevalence – and your exposure – will soar. Much like the arrival of specialty drugs 20 years ago, when what seemed like an anomaly, in fact became the new normal. The truth is, these new therapies are getting FDA approval and payers will need to cover them. You need to get ahead of this issue and accurately predict and proactively manage the impending costs and complexities of these new therapies – and have a team that is supporting and taking care of your employees and members who receive this care.
ETS: The undisputed experts in CGT and transplant
Emerging Therapy Solutions (ETS) is the only company solely focused on this complex and rapidly evolving space, leveraging 30+ years of experience managing cell and gene therapies and transplants. We’re the leading resource for hundreds of payers and the brokers and consultants who advise them, as well as stop-loss and reinsurance carriers—providing unmatched expertise that translates into greater foresight, savings, and peace of mind.
OUR SOLUTION
A total-coverage solution for CGT and Transplant:
Comprehensive, proactive and protective.
Our solution starts with proactively identifying patients, and goes through treatment conclusion and outcomes monitoring. It’s about supporting access to high-quality providers, for incredibly complex services, all at the best price for your total population over time. Partnering together throughout the entire process is how to get to value.
A continuous, data-driven analysis of your population to pinpoint members most likely to require cell or gene therapy. This insight enables precise forecasting of your anticipated spend over the coming months and years, factoring in both current and upcoming therapy approvals. This gives you clear visibility into the financial and clinical impact on your managed population.
Once patients are identified, care navigators direct your members to therapy-specific COEs with transparent high-value financial terms, assist with appointments, travel, financial aid, and support. We offer a holistic approach to care navigation, backed by expert physician consultation. Throughout treatment, we monitor both the patient journey and care delivery, ensuring ongoing support and tracking treatment responses.
A comprehensive solution ensures patients get the right care at top facilities, optimizing outcomes and costs, while delivering high-value transparent pricing. Our Centers of Excellence build a network of top providers, while your team is equipped with medical policies, prior authorizations, and strategic plans for seamless treatment. If expected outcomes are not met, we can provide access to value-based contracts with the pharmaceutical manufacturers to get a portion of the claim refunded.
As part of our comprehensive approach, ETS also provides risk pooling and risk transfer solutions from our financial management partners, allowing you to further mitigate and plan for upcoming claims risk.
WHO WE SERVE
Those with the greatest need can get the most value.
Self-Insured Employers
Self-funded employers face unique challenges in predicting and balancing CGT costs with employee needs and benefits. While the looming risk of CGT can feel like a remote threat and something that can be put off until later, it’s not.
Health Plans
Health plans typically don’t have the bandwidth to accurately assess CGT risk, track the pipeline, develop proper COEs, and write medical policies. As the number of these costly cases continues to grow, staying ahead of them is critical.
Secondary Payers
With catastrophic cost claims becoming more regular, it is increasingly important for secondary payers to see, understand and plan for the current and upcoming risks across their populations. This can support forecasting, underwriting, pipeline monitoring, and access to care for patients.
OUR STORY
A trusted partner for transformative therapies.
Our story began in the late 1980s, with our founder David J. McLean, when organ transplants were the emerging high-cost, high-stakes treatments. Our experience helping payers anticipate, plan and manage these complex cases taught us much about the end-to-end services needed to bring true value to the unpredictable and rapidly expanding CGT market.
Don’t wait. We are ready to help you manage your risk.