Marshall Introduces Bipartisan Legislation to Improve Access to Groundbreaking Therapies
WASHINGTON, D.C. – This week, Congressman Roger Marshall, M.D., introduced H.R. 5882, the GENE Therapy Payment Act with Reps. Kurt Schrader (D-OR), Jason Crow (D-CO), Markwayne Mullin (R-OK), Ami Bera, M.D. (D-CA), Mike Kelly (R-PA), and David Schweikert (R-AZ). This legislation will help those with life-threatening illnesses who can benefit from gene therapy treatments.
“Gene therapy has the potential to cure cancer and treat debilitating diseases, putting it at the forefront of medical innovation,” said Rep. Marshall. “It works by reengineering a patients’ cells then reintroducing them to combat the disease. Administering this therapy is unlike other treatments and will require a new type of payment model. The GENE Therapy Payment Act encourages the adoption of value-based models for reimbursement of gene therapies by creating a payment system in the Medicaid program. I’m proud to join my colleagues in introducing this bipartisan legislation that can help medical professionals bridge the gap of patient outcomes with the highest quality of care.”
These groundbreaking therapies can be incredibly expensive, and this legislation will create allow for a new value-based payment system so that Medicaid beneficiaries can receive these innovative treatments.
H.R. 5882 sets up a framework for the approval of value-based arrangements for gene therapies in Medicaid. It gives states the option to pay for covered outpatient drugs that are potentially curative treatments intended for one-time use through risk-sharing value-based payment agreements with manufacturers. The proposal is an improvement over current options to pursue these arrangements because it outlines payment based on achieved outcomes, rather than monthly subscription models that are being utilized in some states.
“The GENE Therapy Payment Act will allow for value-based payments in Medicaid so that more Americans can benefit from potentially curative and groundbreaking gene therapies,” said Rep. Schrader. This is commonsense, bipartisan legislation that will help everyday Americans access the care that they need, without bankrupting state Medicaid programs, allowing for shared risk that will reward the companies working to advance these extremely expensive treatments, when and only when they obtain anticipated outcomes.”
“We have the ability to cure patients who struggle with debilitating diseases like cancer, heart disorders, hemophilia, and sickle cell disease with one treatment,” said Rep. Mullin. “Drug developers are taking extraordinary risks to invest in these groundbreaking therapies, which could easily cost millions of dollars per patient once they reach the market. These cures are in the drug approval pipeline and will soon come to the market, but without an affordable way for consumers to pay for them it will be hard for patients to access. This bill will help policy catch up to science and give patients access to the live-saving treatments they need.”
“As a doctor, I know that getting patients the right treatment as quickly as possible can be the difference between life and death,” said Rep. Bera. “While Congress debates the best way to lower health care costs, we have genetic therapies that can be treating and maybe curing people right now—many of them children—if only patients could have access to them. I’m proud to support the GENE Therapy Payment Act because it would give states the flexibility to enter into value-based contracts for these treatments to make them more affordable for states and accessible to patients who need them.”
“I am pleased to be a co-sponsor of this legislation that continues the work we are doing to cure our brothers and sisters with life-threatening illnesses,” said Rep. Schweikert. “We are seeing incredible innovations in gene-therapy that, though expensive, will crash the price of providing care and open the door for new treatment options. As a society, we must continue thinking creatively to help foster a healthier society, encourage innovation, and provide families the resources they need after being diagnosed.”
The bill is a companion to a provision in the Senate Finance Committee’s bipartisan legislation, S.2543, the Prescription Drug Pricing Reduction Act.