A viewpoint in the Journal of Managed Care & Specialty Pharmacy reviewed the CMS Cell and Gene Therapy (CGT) Access Model for sickle cell disease, describing the payment framework and identifying persistent implementation gaps. The model uses outcome-based agreements to tie reimbursement to demonstrated therapeutic benefit, with expected Medicaid cost reductions over five years cited by the authors. However, the authors flagged key barriers, including fertility preservation coverage limitations. They noted that although the model covers fertility preservation, it may not cover IVF access—potentially restricting downstream options for Medicaid beneficiaries after gene therapy’s chemotherapy conditioning. The review also pointed to data tracking issues if patients lose Medicaid coverage during follow-up, weakening the mechanism intended to verify outcomes and sustain financing predictability.