Variation in Medicaid and commercial coverage of cell and gene therapies

Date: December 15, 2023
Journal: Health Policy Open
Citation: Molly T. Beinfeld, Julia A. Rucker, Nola B. Jenkins, Lucas A. de Breed, James D. Chambers, Variation in Medicaid and commercial coverage of cell and gene therapies, Health Policy OPEN, Volume 5, 2023, 100103, ISSN 2590-2296, https://doi.org/10.1016/j.hpopen.2023.100103

Growth in the availability of cell and gene therapies (CGTs) promises significant innovation in the treatment of serious diseases, but the high cost and one-time administration of CGTs has also raised concern about strain on health plan budgets and inequity in access. We used coverage information from the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database for 18 large commercial health plans in the US and information from state Medicaid websites to examine variation in coverage of 11 CGTs. We conclude that there is variation in access to CGTs, creating differential patient access.

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