The Cell and Gene Therapy Access Model is an innovative program of the Centers for Medicare and Medicaid Services (CMS) that aims to improve patient access to gene therapies, particularly for people with sickle cell disease.[1][2] The program allows states and drug manufacturers to enter into outcome-based agreements, where payments are tied to whether the therapy actually produces the promised health benefits.[1][2] As of July 2025, 33 states, along with the District of Columbia and Puerto Rico, have joined the model, covering approximately 84% of sickle cell disease patients insured through Medicaid in those states.[2] According to the Centers for Disease Control and Prevention, sickle cell disease affects approximately 100,000 people in the US.[2] The model addresses the high cost of these therapies, which can cost millions of dollars, and allows states to receive guarantees for discounts and rebates if the therapies do not produce the expected results.[1][2] The program also provides support for patients' fertility preservation, an important recognition of quality of life.[3] The model began in January 2025, and all 50 states could join anytime between January 2025 and January 2026.[3]