New CMS Model Aims to Expand Access to Cell and Gene Therapies

The Centers for Medicare and Medicaid Services (CMS) Innovation Center will test a new access model that aims to help expand access to cell and gene therapies for illnesses like sickle cell disease and cancer.

Under this model, state Medicaid agencies would assign CMS to coordinate and administer multi-state, outcomes-based agreements with manufacturers for certain cell and gene therapies. As new therapies come to market, the model could help Medicaid beneficiaries access advanced therapies whose costs currently total more than $1 million.

Secretary of Health and Human Services Xavier Becerra selected this and two other models this week in response to President Joe Biden’s October 2022 executive order on lowering the cost of prescription drugs. The other two models address cost sharing for generic drugs and payment methods for drugs approved under accelerated approval.

A fact sheet and FAQ document are available online.