Oregon to get Lower-Cost & Lifesaving Treatment in 2026

Beginning January 1, 2026, Oregon will be able to increase access to lower-cost, lifesaving cell and gene therapies for people on Oregon Health Plan (OHP), the state’s Medicaid program.

Oregon is one of 35 states that applied in 2024 to join a multi-year initiative with the Centers for Medicare & Medicaid Services (CMS) to negotiate lower costs for innovative therapies. By lowering costs for participating states, the Cell and Gene Therapy Access Model will improve access to transformative treatments for people who have health coverage through Medicaid and live with a rare or severe disease.

States will initially focus on providing lower-cost therapies for people living with sickle cell disease, a genetic blood disorder that affects 120,000 individuals nationally, the majority of whom are Black, African American and/or Hispanic. Approximately 800 Oregonians live with sickle cell disease.

The average lifespan for people living with sickle cell disease is 20 years shorter than the national average life expectancy. Individuals living with the disease can experience severe and painful symptoms such as organ damage and strokes, resulting in multiple hospitalizations, organ failure and even death. CMS estimates that 50-60% of people living with sickle cell disease are enrolled in Medicaid and the U.S. health system spends $3 billion each year on care for people living with the disease.

“The cost of cell and gene therapies for sickle cell disease is a real barrier that prevents Oregonians from living longer, healthier lives with less pain and fewer trips to the emergency room,” said Emma Sandoe, Medicaid Director for Oregon Health Authority. “This initiative is a big step forward in promoting innovative treatments and increasing access to lifesaving treatment.”

Cell and gene therapies are one-time treatments that can transform lives by correcting underlying causes of a disease, addressing symptoms and stopping the progression of diseases. However, gaining access to these potentially life-changing treatments can be difficult because they can cost millions of dollars.

Through the Cell and Gene Therapy Access Model, CMS will negotiate agreements with participating pharmaceutical manufacturers on behalf of states. Pricing for treatments will be tied to specific outcomes for Medicaid members including improved access to innovative treatment, improved health as well as reductions in health care costs and burdens to state Medicaid programs.