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Sickle Cell Gene Therapy In Medicaid: CMMI Model As ‘Bandwidth Extender’ For Less Resourced States

 
• By Cathy Kelly and Sarah Karlin-Smith

Outcomes-based contract that federal government will negotiate with manufacturers on behalf of Medicaid programs might not be appealing to large states. Bluebird and Vertex can apply to the demonstration project this spring and negotiations would follow between May and November.

Working To Facilitate Access To High-Cost, Cutting Edge Therapy • Source: Shutterstock

The Center for Medicare and Medicaid Innovation’s new payment model for gene therapies for sickle cell disease in Medicaid got a cautious reception from bluebird bio and Vertex Pharmaceuticals Incorporated after it was announced on 30 January.

Uncertainty about whether the manufacturers of the two approved gene therapies for sickle cell disease could agree on a price with the Centers for Medicare and Medicaid Services and concerns that states might postpone contracting with

Key Takeaways

  • The CMMI model for cell and gene therapy will launch in 2025 for sickle cell treatments.

  • Bluebird bio’s Lyfgenia and Vertex/CRISPR Therapeutics’ Casgevy are candidates for the demonstration project.

  • The companies are engaged with CMMI on the project but will continue to negotiate contracts directly with Medicaid programs

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