Advancing Access to Cell and Gene Therapies in Medicaid
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JAMA. 2024 Jun 18;331(23):1989-1990. doi: 10.1001/jama.2024.6224. PMID: 38776090.

Advancing Access to Cell and Gene Therapies in Medicaid

Authors: Joseph T Kannarkat 1Inmaculada Hernandez 2Natasha Parekh 

Affiliation:

  1. School of Medicine, University of Maryland, Baltimore.
  2. Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla.
  3. Marathon Health, Indianapolis, Indiana.

Abstract:

The Biden administration’s stated priority to increase access to novel cell and gene therapeutics while controlling their costs culminated with the January 2024 release of the Cell and Gene Therapy Access Model by the Center for Medicare and Medicaid Innovation (CMMI).1 The model seeks to test if outcomes-based agreements developed by the CMMI for novel cell and gene therapies could improve access and equity while controlling costs in Medicaid.

Pharmaceutical outcomes–based agreements are contracts between payers and manufacturers that tie drug rebates to outcomes after treatment initiation. Under the proposed model, state Medicaid agencies would uniquely allow the CMMI to negotiate supplemental rebates for cell and gene therapies on their behalf. These supplemental rebates would not supersede but add to base rebates stipulated by the Medicaid Drug Rebate Program. This Viewpoint presents the components of the payment model and the implementation challenges among the CMMI, state Medicaid agencies, patients, and manufacturers.

Download: https://pubmed.ncbi.nlm.nih.gov/38776090/