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CGT Access Model

Cell and Gene Therapy Access Model

The Cell and Gene Therapy (CGT) Access Model is a multi-year, voluntary model for states and manufacturers to test outcomes-based agreements for cell and gene therapies. It aims to increase Medicaid beneficiaries' access to innovative treatments, improve health outcomes, and reduce health care costs and burden to state Medicaid programs. The initial focus is on gene therapy treatments for sickle cell disease.

Active since 2025-01-01Application deadline 2025-03-14

Innovation

Instead of each state creating and implementing its own outcomes-based agreements with manufacturers, the model allows CMS to bring states together and negotiate on a multi-state basis, establishing financial and clinical outcome measures, reconciling data, and evaluating results.

The Problem

Cell and gene therapies can transform the lives of people living with rare and severe diseases that are hard to treat, but gaining access to these potentially life-changing treatments is difficult because they can cost millions of dollars.

The Solution

The CGT Access Model supports outcomes-based agreements between states and manufacturers that will provide treatments within a framework that lowers prices for states and ties payment to outcomes.

Expected Outcomes

By increasing access to transformative therapies, this model aims to improve the poor health outcomes and low life expectancy associated with rare and severe diseases like sickle cell disease, as well as make it easier for states to pay for cell and gene therapies.

Strategy

The model underscores CMS’ commitment to accelerating access to innovative therapies, improving patient health, and tying payment to outcomes.

Model Goals

  • Increase Medicaid beneficiaries’ access to innovative treatment
  • Improve health outcomes for people living with rare and severe diseases
  • Reduce health care costs and burden to state Medicaid programs

Patient Eligibility

Medicaid beneficiaries receiving gene therapy for severe sickle cell disease.

  • Medicaid is the primary payer
  • Living with severe sickle cell disease
  • Receiving FDA-approved gene therapy for SCD

Provider Eligibility

Health care providers are not direct participants in the model, but treatment centers must meet specific qualifications to administer the therapies.

  • Must be a qualified SCD gene therapy provider
  • Must be enrolled in the state Medicaid program
  • Must be a member of the CMS-designated patient registry (CIBMTR) and participate in the study

Care Categories

Genetic Blood Disorders

Sickle cell disease

CMS Benchmarks & Thresholds

financial

LYFGENIA™ List Price Per Patient3,100,000
Maximum Cooperative Agreement Funding$9,550,000
CASGEVY™ List Price Per Patient2,200,000

operational

State Participation Start Year (Minimum)2,025
State Participation Start Year (Maximum)2,026
Cooperative Agreement Award Start DateAugust 1, 2025
First State Participation Start DateMarch 1, 2025
Model Performance Years Count11
Model Performance Period End DateDecember 31, 2035
Evaluation Reports Start Year2,027
Evaluation Reports End Year2,035
State Application Deadline MonthMarch 2025
All Populations in Model Deadline DateJanuary 1, 2026
Fertility Preservation Storage Duration5 – 15
Notice of Funding Opportunity Application Deadline DateMarch 14, 2025
Cooperative Agreement Duration (Years)10
Implementation Funding Reporting Frequencyquarterly
CBO Partnership List Reporting Frequencyquarterly
CBO Full Performance Report Frequencyannually
Managed Care Alignment Deadline Year2,026
Cooperative Agreement Duration (Months)5

population

Number of State Participants34
Number of Manufacturer Participants2
Cooperative Agreement Award Recipients Count8
Sickle Cell Disease Medicaid Coverage Percentage0.5% – 0.6%
Medicaid Beneficiaries with SCD Representation in Model0.84%

quality

Patient-Reported Outcomes Survey Frequency Post-Infusionprior to infusion,30 days post-infusion,100 days post-infusion,180 days post-infusion,1-year post-infusion,annually thereafter, up to five years post-infusion

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