payor coverage
Vertex Pharmaceuticals, Bluebird Bio to Participate in CMS Cell and Gene Therapy Access Model
CMS has negotiated outcomes-based agreements for sickle cell gene therapies with the two companies on behalf of participating state Medicaid programs.
After years of persistence, genetic counselors at UT Southwestern got BCBS of Texas to fix a system error that was leading to payment denials for services.
CMS Rolling Out New Payment Policy for High-Cost Diagnostic Radiopharmaceuticals
The government payor said it will separately pay for specialized diagnostic radiopharmaceuticals without transitional pass-through payment status.
Myriad Genetics Stock Tanks After UnitedHealthcare Pulls Coverage of PGx Panels
The payor had been covering Myriad's GeneSight assay since 2019 but has decided there is not enough evidence showing this type of test is medically necessary.
Payors, Pharma Engage Alternative Payment Models Amid High Gene Therapy Cost, Efficacy Unknowns
Premium
Drugmakers and insurers are exploring different payment schemes for expensive, potentially curative treatments, particularly ones tied to patient response.