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Medicaid Outcomes-Based Payment Model For Cell, Gene Therapy to Launch In 2025

 
• By Cathy Kelly

But CMMI does not yet have a launch date for the proposed Medicare demonstration on drugs cleared through FDA’s accelerated approval pathway and the demonstration allowing Part D plans to offer certain high-value generics with a $2 beneficiary copay.

Will All Of Biden's Drug Pricing Demos Advance If He's Not Re-Elected? • Source: Shutterstock

The Center for Medicare and Medicaid Innovation is accelerating the implementation schedule for a payment demonstration testing a multi-state, outcomes-based contracting approach for cell and gene therapies and now expects to begin in 2025 instead of 2026.

Key Takeaways

  • Cost concerns among Medicaid programs is accelerating CMMI’s plans to launch a demonstration involve multi-state outcomes-based contracts for cell and gene therapy.

  • CMMI does not yet have a launch date for a model designating differential reimbursement for drugs approved by the US FDA via the accelerated pathway, though it believes it would be a useful experiment

The demonstration is one of three models for lowering prescription drug costs that CMMI is working on in response to an Executive Order issued by President Biden a year ago

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