How will Medicaid pay for sickle cell gene therapies?

The FDA recently approved two curative gene therapies for sickle cell disease, but the costs of these drugs — $2.2 million and $3.1 million — are creating a strain for government health coverage. About 100,000 Americans have the disease, and between 30% and 40% of these people are believed to rely on Medicaid for care. While not all of them would be eligible for the new wave of sickle cell gene therapies or even want to take them, the cost would still be staggering.

“The magnitude of the cost is really dwarfing anything we’ve seen before,” the executive director of the National Association of Medicaid Directors told STAT’s Ed Silverman. “The key argument is whether the investment in curative therapies would offset future costs. But it will be extraordinarily difficult for the state programs to solve this on their own.”

The Centers for Medicare & Medicaid Services is developing a pilot program to help create outcomes-based agreements between state Medicaid programs and cell and gene therapy manufacturers.

https://www.statnews.com/2024/01/29/biotech-news-23andme-sarepta-pfizer-novo-nordisk-novartis-gsk-merck-sanofi-roche/