North Carolina CGT Access Model - The North Carolina state Medicaid agency, known as the NC Department of Health and Human Services (NCDHHS) Division of Health Benefits (DHB), seeks to implement a set of activities aimed at ensuring the successful implementation of the Centers for Medicare & Medicaid Services (CMS) Cell and Gene Therapy (CGT) Access Model. Through this funding opportunity, North Carolina endeavors to bolster state and partner organization capacity to provide gene therapy treatments and support beneficiaries undergoing treatment; educate beneficiaries living with sickle cell disease (SCD) on novel gene therapy treatment options; and empower beneficiaries living with SCD to engage with new treatment offerings. The overarching goals of this project are to strengthen state capacity to ensure sufficient access to cell and gene therapies for beneficiaries living with SCD. Activities that will be undertaken to achieve this goal include: · Developing and administering a targeted education and awareness campaign, directed at relevant providers and eligible beneficiaries, to (a) increase awareness of gene therapy treatment options for SCD, (b) explain Medicaid coverage for gene therapy treatments through the CGT Access Model, and (c) educate individuals about the resources available to support beneficiaries on their care journey while receiving gene therapy treatment for SCD; · Hiring one full-time Clinical Pharmacist to provide expertise and support DHB’s Pharmacy and Ancillary Services Business Unit related to the CGT Access Model; · Enhancing state technological systems utilized for processing rebates to support the state’s reimbursement approach under the CGT Access Model; · Establishing and supporting two Memorandum of Agreements (MOAs) with the two in-state providers of approved gene therapy for SCD to support care coordination for and connect beneficiaries undergoing gene therapy with health-related social needs services. Funds will be allocated for the development and implementation of an educational campaign, departmental staffing, and external contracts. DHB aims to expand its reach, capacity, and infrastructure related to SCD gene therapies, thus allowing DHB to efficiently participate in the CGT Access Model and implement seamless treatment pathways. Total budget for the activities over the course of 11 years is $5,191,151.43. The effort undertaken by DHB, with insight and guidance from NC’s two in-state treatment centers along with other external partners, is focused on expanding access to gene therapy, improving care coordination, and increasing access to treatment for Medicaid beneficiaries with SCD in North Carolina. This includes addressing critical gaps in provider awareness, beneficiary education, and logistical support that contribute to delayed or incomplete treatment. By establishing sustainable partnerships and infrastructure to implement the CGT Access Model, DHB is committed to reducing hurdles to accessing treatment, facilitating successful completion of treatment, and supporting positive health outcomes.
