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What’s new: 33 states, the District of Columbia, and Puerto Rico signed agreements with CMS to participate in the Cell and Gene Therapy (CGT) Access Model.
Why it matters: 84% of Medicaid beneficiaries with sickle cell disease reside in states that are participating in the model.
What to expect: Medicaid beneficiaries with sickle cell disease will have greater access to transformative therapies.
The big picture: These agreements are part of the CGT Access Model, a first-of-its kind model in which the federal government negotiates outcomes-based agreements with CGT manufacturers on behalf of state Medicaid agencies. Under the model, participating states receive guaranteed discounts and rebates from participating CGT manufacturers if the therapies fail to deliver their promised therapeutic benefits.
Additional details: The states that signed agreements to participate in the model are Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin, as well as the District of Columbia and Puerto Rico.
The CMS Innovation Center intends to consider additional conditions for the model and continues to engage with interested parties regarding these conditions as well as other directions for the model. Please reach out to the CGT Access Model Team at CGTModel@cms.hhs.gov using the subject line “Future Model Considerations” to provide input.
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