Managed care journal calls for new copayment models for cell and gene therapies

A peer-reviewed article in The American Journal of Managed Care argues that traditional patient copayment structures are inadequate for million-dollar cell and gene therapies, creating access barriers and reimbursement disputes. The analysis suggests payers may adopt novel models such as outcome-based payments, installment copays, or manufacturer-backed warranty programs. CMS and commercial payers are already piloting alternative payment arrangements for CAR-T and gene therapies for conditions like sickle cell disease. While no immediate policy change is announced, this signals ongoing payer experimentation with financial mechanisms for ultra-high-cost treatments. For oncology and specialty practices, this means future prior-auth and benefits-investigation processes for these therapies may involve new financial-counseling steps and payer-specific contracts beyond standard medical review.