States Shift Away from Bundled Payments for Cell and Gene Therapies to Capture Rebates

Medicaid programs are increasingly moving away from bundled payment methodologies for cell and gene therapies in order to separately identify these drugs and collect manufacturer rebates under the Medicaid Drug Rebate Program. This shift provides more predictable reimbursement for providers but increases rebate exposure for manufacturers. The piece also explores the expansion of CAR-T administration into community outpatient settings and implications for access and reimbursement across payer types.

Pharmacy · Managed Care · Finance

This is outside commentary from Avalere, not part of Medicaid Monitor's independently scored news coverage.

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