For the approximately 100,000 Americans living with sickle cell disease — and for the Medicaid programs that cover between 50 and 60 percent of them — the era of gene therapy coverage has arrived. But the coverage comes with an innovative condition: the manufacturer only gets paid in full if the therapy actually works.
The Centers for Medicare & Medicaid Services announced that 33 states, plus the District of Columbia and Puerto Rico, will participate in the Cell and Gene Therapy (CGT) Access Model, a bold new approach to delivering cutting-edge treatments for people on Medicaid living with sickle cell disease. Participating states represent approximately 84% of Medicaid beneficiaries with the condition, significantly expanding access to transformative care.
