Document Type
Presentation
Publication Date
Fall 10-5-2026
Abstract
High-cost gene therapies lists at $0.85M–$3.5M per treatment, and Medicaid coverage requirements obligate state programs like TennCare to confront reimbursement they were not designed to absorb. Objective: To map what existing literature reports on gene therapy access models, financing, equity, and coverage barriers to inform TennCare policy. Methods: JBI/PRISMA-ScR scoping review; 245 sources charted across four themes (access barrier, financing model, equity focus, payer relevance, study design). Results: Pricing/affordability is the dominant barrier for patients (67%). Outcomes-based contracts are the leading proposed financing mechanism and cluster in Medicaid-relevant work. Conclusions: Evidence points to outcomes-based, multi-state Medicaid financing, anchored by the CMS Cell and Gene Therapy Access Model, as the most viable path for TennCare gene therapy coverage.
Recommended Citation
Henderson, Trey and Fuesting, Brandy, "Gene Therapy Access, Financing, and Equity for Medicaid Populations: A Scoping Review to Inform TennCare Coverage Policy" (2026). DO Research Day. 4.
https://digitalcommons.lmunet.edu/doresearch/4
