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Delayed and Inadequate: Launch Prices and Medicaid Access to New Cures

State Medicaid programs face significant challenges in providing access to expensive new medications due to budget constraints. Recent drug approvals, particularly gene therapies, offer potential cures for conditions disproportionately affecting Medicaid enrollees. However, the high costs—ranging from $2 million to $3 million per patient—pose substantial financial hurdles. This article discusses how Medicaid and other payers might collaborate to ensure equitable access to these life-saving treatments while maintaining financial stability. Click here for article.

  • Impact of High Launch Prices: Initial high prices for new drugs, such as those seen with hepatitis C treatments, can severely limit patient access despite later price reductions due to competition​ (KWBU)​.

  • Collaboration for Better Access: Centralized negotiations and outcomes-based agreements, as proposed in the new Cell and Gene Therapy Access Model, could improve access to costly therapies like those for sickle cell disease by leveraging collective bargaining power​ (KWBU)​.

  • Geographic and Financial Disparities: Even with centralized Medicaid negotiation, voluntary participation and varying state budgets could lead to disparities in access to treatment. Some states might struggle to fund treatments even at reduced prices​ (KWBU)​.

  • Need for a National Strategy: A broader, national approach to negotiating and funding curative therapies could ensure equitable access. This could involve a subscription model or a single-payer system for cures, funded through insurance premiums and taxes, similar to the approach taken for COVID-19 vaccines​ (KWBU)​.

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