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Sickle Cell Gene Therapy Uptake May Lag, But Still Shock State Medicaid Budgets

 
• By Sarah Karlin-Smith

Medicaid state programs, expected to be the majority payers for the new gene therapies, lack certain flexibilities to help them quickly adapt to high-priced treatments, particularly given the huge jump from current sickle cell treatment costs to the just-approved breakthroughs.

3d render of exponential red arrow pointing upwards
State Medicaid programs will face exponential new costs for sickle cell patients with new gene therapies • Source: Shutterstock

Coverage of new sickle cell gene therapy treatments in US state Medicaid programs is likely to lag due to the treatment’s big initial sticker shock to the state health insurance systems and the unique policy determinations that states must make to execute coverage of drugs that can only be given in limited locations nationwide and must be coupled with other high-cost medical care.

Medicaid is estimated to account for about 50% of the 100,000 sickle cell disease patients in the US, and the yearly budget for these patients is estimated to increase exponentially due to the newly approved products: Vertex Pharmaceuticals Incorporated/CRISPR

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