As newly developed, innovative therapies come to market, policymakers continue to explore sustainable financing solutions to pay for these life-changing medicines. Outcomes-based arrangements (OBAs) – which base reimbursement on whether or not a therapy worked- are one tool to help manage costs. This is particularly applicable to gene therapies for rare diseases, where the pipeline is robust, and the need is great. The U.S. federal government has taken steps through rulemaking to enable these arrangements. Some states are leading the way through Medicaid State Plan Amendments (SPAs), with Oklahoma Medicaid implementing some of the earliest OBAs. As more states investigate financing options for gene therapies, this paper reviews example OBAs and key lessons learned from states with existing contracts.
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