Maryland Medicaid to Slash Sickle Cell Gene Therapy Costs for Patients

Maryland is taking a major step to make cutting-edge treatments affordable. The state’s Medicaid program is joining a new federal initiative. This will drastically lower the cost of life-saving cell and gene therapies for sickle cell disease.

The move was confirmed by the Maryland Department of Health. It is part of a national effort to improve access to these expensive, one-time treatments. The program is set to begin in early 2026.

New Federal Model Drives Down Drug Prices

The initiative is called the Cell and Gene Therapy (CGT) Access Model. It is run by the Centers for Medicare & Medicaid Services (CMS). According to Reuters, this model allows CMS to negotiate directly with drug manufacturers.

These negotiations focus on outcomes-based agreements. The state receives enhanced rebates tied to a treatment’s success. This approach mitigates the massive upfront cost for states.

The Maryland Department of Health estimates significant savings. They project saving over $1 million per patient. These savings will allow more people to receive the care they need.

Expanding Access to Lifesaving Breakthroughs

This decision directly impacts thousands of residents. Approximately 3,000 Maryland Medicaid participants live with sickle cell disease. The condition disproportionately affects Black communities.

Two authorized treatment centers in the region will provide the therapies. Patients can go to the University of Maryland Medical Center or Children’s National Hospital. This partnership is a game-changer for public health.

Officials say the model is a new way of thinking. It prioritizes patient outcomes over pure cost. This ensures Medicaid funds are spent on effective, groundbreaking medicine.

This move makes Maryland Medicaid a leader in accessible healthcare innovation. The state’s action directly addresses the high cost of sickle cell gene therapy. It sets a new standard for public health programs nationwide.

Info at your fingertips

What is the Cell and Gene Therapy Access Model?

It is a federal program run by CMS. It negotiates rebates with drugmakers for states. The rebates are tied to how well a treatment works.

When does the new pricing start?

The new rebates and financial protections begin on January 1, 2026. Maryland Medicaid patients can currently access these therapies but at a higher cost.

Who is eligible for these treatments?

Maryland Medicaid participants diagnosed with sickle cell disease are eligible. An estimated 3,000 people in the program have the condition.

Where are the treatments available?

There are two authorized treatment centers. They are the University of Maryland Medical Center in Baltimore and Children’s National Hospital in Washington, D.C.

Why are these therapies so expensive?

They are complex, one-time procedures that alter a patient’s genes. The development and manufacturing costs are extremely high, leading to multi-million-dollar price tags.

Trusted Sources: Centers for Medicare & Medicaid Services (CMS), Maryland Department of Health, Reuters