CMS Announces 33 States Participating in CMMI CGT Access Model

This article was exclusively distributed to subscribers on July 21, 2025. Click to receive additional information about how to subscribe and to activate a complimentary trial subscription.


On July 15, the Centers for Medicare & Medicaid Services (CMS) that 33 states, plus D.C. and Puerto Rico, will participate in the Center for Medicare and Medicaid Innovation (CMMI) Cell and Gene Therapy (CGT) Access Model for Medicaid enrollees seeking treatment for sickle cell disease (SCD). According to the press release, participating states represent approximately 84 percent of Medicaid beneficiaries with the condition.

The CGT Access Model will test whether a CMS-led approach to developing and administering outcomes-based agreements (OBAs) with pharmaceutical manufacturers improves Medicaid beneficiaries’ access to these innovative treatments, improves their health outcomes, and reduces long-term health care costs and burdens for state Medicaid programs.

Under the voluntary model, CMS has negotiated key terms of an OBA with two manufacturers of gene therapies for SCD: bluebird bio and Vertex Pharmaceuticals. The CMS-negotiated OBA ties Medicaid supplemental rebates for these gene therapies to outcomes for patients with SCD. States that choose to participate in the model agree to execute the CMS-negotiated OBAs with one or both of the participating manufacturers. The OBAs will govern Medicaid coverage and payment for SCD treatment in particular states.

Although the CGT Access Model is currently focused on treatment for SCD, CMMI has signaled interest in potentially expanding the model to cover additional disease states. On its website, CMMI states that it “look[s] forward to continuing to engage with interested parties, including states and manufacturers of cell and gene therapies, regarding future conditions the model might include as a focus area, or other directions the CGT Access Model might consider” and directs interested stakeholders to reach out via to CMMI’s CGT Access Model Team using the subject line “Future Model Considerations” to provide input.


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According to the CMS announcement, the following states and territories are participating in the CGT Access Model: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin, as well as D.C. and Puerto Rico.