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Casgevy, Lyfgenia Medicare Add-On Payments In Sickle Cell Are Not Conditioned On Outcomes-Based Contracting

 
• By Cathy Kelly

The CMS supplemental reimbursement for the gene therapies is higher than usual for new technologies, but is similar to the formula used for antibiotics.

Hospitals Still Face High Medical Costs Associated With the Gene Therapies Treatment. • Source: Shutterstock

Multi-million dollar gene therapies for sickle cell disease from Vertex Pharmaceuticals Incorporated and bluebird bio will get a Medicare reimbursement boost in 2025 and up to two years afterward, which could help encourage uptake by healthcare providers.

Key Takeaways

  • Vertex’s Casgevy and bluebird bio’s Lyfgenia were awarded Medicare new technology add-on payments for use in sickle cell disease starting in 2025.

The Centers for Medicare and Medicaid Services announced 1 August that Medicare will pay the lesser of:

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