33 States to Participate in Medicaid’s CGT Access Model for SCD

The Centers for Medicare and Medicaid Services (CMS) announced Tuesday that 33 states, along with the District of Columbia and Puerto Rico, will participate in the Cell and Gene Therapy (CGT) Access Model, which will focus on sickle cell disease (SCD) treatment. Participating jurisdictions represent about 84% of Medicaid enrollees with SCD.

Under the CGT Access Model, CMS negotiated outcomes-based agreements between states and pharmaceutical manufacturers that tie pricing for cell and gene therapies (CGT) for individuals with rare and severe diseases to tangible improvements in health outcomes. 

The approach aims to improve health outcomes while reducing long-term costs by offering states guaranteed discounts and rebates from participating CGT manufacturers if therapies do not meet expected therapeutic benefits. The model may expand to cover other high-cost therapies in the future.