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Medicaid's new model pays for sickle cell gene therapies only if they work, involving major drugmakers and 34 jurisdictions.
Medicaid has launched a new outcome-based payment model for gene therapies treating sickle cell disease, where states only pay if treatments succeed.
The initiative, begun under Biden and continued under Trump, involves Vertex Pharmaceuticals and Bluebird Bio, who will provide discounts or rebates if therapies fail to deliver results.
The high-cost treatments, priced between $2.2 million and $3.1 million per patient, aim to cure a genetic disorder affecting about 100,000 primarily Black Americans.
Thirty-three states, Washington, D.C., and Puerto Rico have joined, seeking to control costs while improving access.
CMS has not disclosed financial terms, citing confidentiality.
Early results from patients like Serenity Cole show reduced pain and better quality of life, though long-term effectiveness remains under evaluation.
The model could set a precedent for future high-cost gene and cell therapies.
El nuevo modelo de Medicaid paga por las terapias génicas de células falciformes solo si funcionan, involucrando a los principales fabricantes de fármacos y 34 jurisdicciones.