Gene and Cell Therapy Program

AultCare offers an industry-leading solution, in its collaboration with Emerging Therapy Solutions (ETS), for managing the risk associated with the emergence and rapidly evolving space of gene and cell therapies. This service includes a defined Centers of Excellence network that focuses on specific therapies, plan document wording, and benefit design that drives the best outcomes and cost.

AultCare collaborates with leading health systems with a history of participating in clinical trials to allow for an additional avenue for sourcing new and complex gene and cell therapies.

This program supports to monitor thousands of clinical trials to determine what therapies will be coming to market and forecast exposures. The program also mitigates risk through access to expert panels of physicians and clinical guidelines that ensure members receive the appropriate treatments based on their sound criteria.

Identification Process

 Prior Authorizations.  Data mining from claims data.  Predictive modeling of patient populations.

Gene and Cell Therapy Program

Risk Management Process

The AultCare Gene and Cell Therapy program includes:  Ongoing monitoring of clinical trials and specialty drug pipeline by ETS.  Access to specialized expert physician panels and clinical guidelines.  Facilitates to control costs and promote quality by: o Establishing a Centers of Excellence Network. o Leveraging unit costs through direct manufacturer rates. o Establishing quality care standards and coverage criteria. o Providing clear plan language for coverage of drugs. o Helping to control Stop Loss expense through improved identification and evaluation of patients.

Outcomes

This program monitors the following indicators and compares them against national standards.  Treatment incidence and prevalence by therapy.  Total plan gene and cell therapy costs.  Therapy costs per treatment.  The number of available therapies and related qualified patients.