CMS’s Cell and Gene Therapy (CGT) Access Model for sickle cell disease is showing promise for Medicaid coverage, but experts say key coverage and data gaps could limit its real-world impact. A viewpoint in the Journal of Managed Care & Specialty Pharmacy evaluated the model’s outcome-based payment approach and its implications for state budgets. The framework ties reimbursement to therapeutic outcomes, aiming to reduce long-term Medicaid costs by shifting expensive, one-time payments into agreements based on demonstrated benefit. The authors cite research projecting possible cost reductions over five years, alongside expected reductions in hospitalizations driven by gene-therapy efficacy. However, the paper highlights unresolved barriers for Medicaid beneficiaries, including limited coverage for fertility preservation options. It also flags data-tracking fragility when some patients lose Medicaid coverage during follow-up, potentially undermining outcome verification tied to reimbursement.