CMS to raise reimbursement on sickle cell disease gene therapies

The US Centers for Medicare & Medicaid Services (CMS) has announced proposals to improve access to gene therapies that have recently been approved for use in the USA for the treatment of sickle cell disease (SCD).

Under its proposed Inpatient Prospective Payment System (IPPS) rule for fiscal year 2025, the CMS said it will reimburse hospitals 75% of the cost of administering Vertex Pharmaceuticals (Nasdaq: VRTX) and CRISPR Therapeutics' (Nasdaq: CRSP) Casgevy (exagamglogene autotemcel), as well as bluebird bio's (Nasdaq: BLUE) Lyfgenia (lovotibeglogene autotemcel). This exceeds the typical 65% new technology add-on payment (NTAP) hospitals receive for cutting-edge treatments.

The US Food and Drug Administration (FDA) first approved Casgevy and Lyfgenia in December last year, marking what was seen as a land-mark decision. The list price for a course of treatment with bluebird bio’s product is $3.1 million, while Casgevy costs $2.2 million per patient.