Medicaid Payment Model For Sickle Cell Gene Therapy May Have Limited Impact Until 2026

 
• By Cathy Kelly
  
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As further details emerge, questions continue about whether the CMMI model could delay access to Lyfgenia and Casgevy; states will be added on ‘rolling basis.’ A new administration could change or cancel the model, but a CMS official predicts that is unlikely.

Will States Buy Into CMMI Model? • Source: Shutterstock

The Center for Medicare and Medicaid Innovation’s planned Medicare payment experiment for gene therapy for sickle cell disease may not have a big impact until at least 2026 because Medicaid managed care organizations will not be included in the model until then.

Key Takeaways

  • Medicaid Managed Care participation in model would not be required until January 2026, which means the majority of Medicaid enrollees may not see the benefit of the model until then.

Under the demonstration, the Centers for Medicare and Medicaid Services would represent a group of states in negotiating outcomes-based agreements...

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