Apr 11, 2024 - Health

Medicare floats incentive for hospitals to offer new sickle cell treatments

Illustration of a view through a microscope looking at dollar sign-shaped cells

Illustration: Natalie Peeples/Axios

Hospitals within months could get extra federal money to administer pricey new gene therapies for sickle cell disease, including the first CRISPR-based treatment.

Why it matters: The Medicare proposal would provide more incentive to offer the multimillion-dollar gene therapies when about half of those living with sickle cell are lower-income people on Medicaid.

How it works: The Centers for Medicare and Medicaid Services on Wednesday proposed paying hospitals an extra 75% of the estimated costs of the treatments on top of what Medicare already pays for the therapy.

  • That's above the typical 65% add-on payment hospitals can get for using new technologies.
  • The proposal follows Food and Drug Administration approval of two sickle-cell treatments in December. CMS announced a pilot program to increase access to the drugs for Medicaid patients in January.

Caveat: The increased payments are contingent on CMS categorizing the treatments as new technologies and would end once therapies age out of their "newness period," CMS said.

Zoom out: CMS on Wednesday also proposed updating hospitals' fiscal 2025 Medicare payments by 2.6%, or $3.2 billion. Hospitals decried the proposal as inadequate in light of inflation and labor challenges.

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