CMS details program to use outcomes-based agreements to pay for sickle cell gene therapies

US Med­ic­aid pro­grams will test a pay­ment mod­el that will re­im­burse mul­ti­mil­lion-dol­lar gene ther­a­pies based on pa­tient out­comes, in an ear­ly step to­ward ef­forts to fi­nance high-sci­ence, high-cost treat­ments.

Start­ing next year, the Cen­ters for Medicare and Med­ic­aid Ser­vices (CMS) will test out­comes-based agree­ments to pay for the sick­le cell gene ther­a­pies. Two of the one-time gene ther­a­pies, Ver­tex and CRISPR Ther­a­peu­tics’ Cas­gevy and blue­bird bio’s Lyf­ge­nia, were ap­proved by the FDA in De­cem­ber with list prices of $2.2 mil­lion and $3.1 mil­lion, re­spec­tive­ly.

Unlock this article instantly by becoming a free subscriber.

You’ll get access to free articles each month, plus you can customize what newsletters get delivered to your inbox each week, including breaking news.