ມີນາ 21, 2025​​ 

SACRAMENTO — The Department of Health Care Services (DHCS), under the direction of Governor Gavin Newsom, this month applied to the Center for Medicaid and Medicaid Innovation (CMMI) at the Centers for Medicare & Medicaid Services (CMS) to participate in the groundbreaking Cell and Gene Therapy (CGT) Access Model. If approved, this multi-year initiative will expand Medi-Cal members’ access to lifesaving gene therapies for sickle cell disease (SCD), a severe genetic blood disorder that disproportionately affects people of African descent.​​ 

“California’s application to participate in this federal model reflects our commitment to expanding access to groundbreaking treatments for Medi-Cal members with sickle cell disease,” said State Medicaid Director Tyler Sadwith. “These therapies have the potential to transform lives, and this initiative helps ensure that cost is not a barrier for Californians who need them most.”​​ 

WHY THIS MATTERS: More than 50 percent of individuals with SCD are covered by Medicaid in the United States. By participating in the CGT Access Model, California will:​​ 

• ຂະຫຍາຍການເຂົ້າເຖິງການປິ່ນປົວພັນທຸກໍາສໍາລັບສະມາຊິກ Medi-Cal ກັບ SCD.​​ 
• ປັບປຸງການຄຸ້ມຄອງໂດຍການຫັນປ່ຽນການປິ່ນປົວເຊື້ອໂຣກ SCD ໄປສູ່ຜົນປະໂຫຍດຄ່າບໍລິການຂອງຮ້ານຂາຍຢາຂອງ Medi-Cal, ເຮັດໃຫ້ມີຂະບວນການຈ່າຍຄືນທີ່ຄາດຄະເນ ແລະຍືນຍົງກວ່າ.​​ 
• ສົ່ງເສີມຄວາມສະເໝີພາບດ້ານສຸຂະພາບໂດຍການເພີ່ມໂອກາດໃນການປິ່ນປົວໃຫ້ແກ່ຊຸມຊົນທີ່ຍັງເຫຼືອຢູ່ໃນປະຫວັດສາດ.​​ 
• ປັບປຸງການຄາດເດົາດ້ານການເງິນສໍາລັບໂຄງການ Medi-Cal ໂດຍຜ່ານການເຈລະຈາຄືນເງິນຂອງລັດຖະບານກາງ.​​ 

“ໂດຍການຂະຫຍາຍການເຂົ້າເຖິງການປິ່ນປົວແບບຫັນປ່ຽນເຫຼົ່ານີ້, ລັດຄາລິຟໍເນຍກຳລັງນຳພາວິທີການແກ້ໄຂຄວາມບໍ່ສະເໝີພາບດ້ານສຸຂະພາບ, ປັບປຸງອາຍຸຍືນ, ແລະຮັບປະກັນວ່າສະມາຊິກ Medi-Cal ທີ່ເປັນພະຍາດເມັດເລືອດແດງຊະນິດ sickle cell ໄດ້ຮັບການດູແລທີ່ດີທີ່ສຸດເທົ່າທີ່ເປັນໄປໄດ້,” Sadwith ກ່າວ.

ກ່ຽວກັບຮູບແບບການເຂົ້າເຖິງ CGT: ການປິ່ນປົວດ້ວຍພັນທຸກໍາເປັນຕົວແທນຂອງວິທີການທີ່ທັນສະໄໝຕໍ່ SCD. ມັນດັດແປງຈຸລັງລຳຕົ້ນຂອງເລືອດຂອງຄົນເຈັບເອງເພື່ອຊ່ວຍໃຫ້ຮ່າງກາຍຜະລິດເມັດເລືອດແດງທີ່ມີສຸຂະພາບດີ. ການປິ່ນປົວຄັ້ງດຽວນີ້ໄດ້ສະແດງໃຫ້ເຫັນວ່າສາມາດຫຼຸດຜ່ອນອາການເຈັບປວດຮຸນແຮງ ແລະ ມີທ່າແຮງທີ່ຈະປ້ອງກັນອາການແຊກຊ້ອນ ແລະ ປັບປຸງຄຸນນະພາບຊີວິດຂອງບຸກຄົນທີ່ເປັນພະຍາດ SCD.​​ 

However, these therapies come with extraordinary costs, making access difficult for patients and Medicaid programs, including Medi-Cal. The CGT Access Model addresses this challenge by using a negotiated rebate system that ties payments for these treatments to patient outcomes. If the therapy does not meet expected health improvements, drug manufacturers will provide rebates to Medicaid programs, helping ensure financial sustainability while expanding access to care.​​ 

Initially, the model will focus on gene therapies for SCD, a condition affecting more than 100,000 individuals nationwide, including more than 8,000 Medi-Cal/Children’s Health Insurance Program (CHIP) members in California.​​ 

If California is approved, eligible Medi-Cal members will have access to gene therapy treatment, case management, travel assistance, behavioral health support, and fertility preservation services, as the treatment process involves chemotherapy, which can impact fertility. CMS anticipates testing the model over an 11-year performance period, beginning on January 1, 2025.​​ 

BIGGER PICTURE: In addition to applying for the CGT Access Model, California was selected earlier this year for the Transforming Maternal Health (TMaH) Model, which aims to improve maternal health outcomes and reduce costs, and is transforming Medi-Cal through its California Advancing and Innovating Medi-Cal (CalAIM) waiver, which focuses on whole-person care, care management, and addressing social drivers of health—strengthening efforts to create a more inclusive and effective health system.​​ 

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ຫ້ອງການສື່ສານ​​ 
(916) 440-7660
DHCSPress@dhcs.ca.gov​​