CMS Starts Outcomes-Based Payment Model for Sickle Cell Drugs

The Centers for Medicare & Medicaid Services unveiled a new outcomes-based payment model with 33 states to expand Medicaid access to gene therapies for sickle cell disease.

• States will get guaranteed discounts and rebates from participating gene therapy manufacturers if their drugs fail to deliver a promised benefit
• CMS will negotiate with companies on behalf of state Medicaid agencies
• States covering 84% of Medicaid sickle cell patients, CMS said
• Optional start dates from Jan. 2025 to Jan. 2026
• Future expansion may include other costly, high-impact diseases

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