ARTICLE | Market Access

New CMS rule fails to fix Medicaid best price

Medicaid best price legislation will continue to impede patient access to expensive gene therapies

January 15, 2022 1:22 AM UTC

Patient access to gene therapies will continue to be impeded by arcane Medicaid best price legislation, even though a CMS final rule which the agency had hoped would fix the problem has now taken effect. 

The crux of the issue is that Medicaid best price — the price at which pharmas must sell drugs to Medicaid — is subject to significant volatility when calculated for gene therapies sold under value-based contracts, and poorly adapted to commercial value-based payment mechanisms...