• Maryland: Last week, CMS announced that 33 U.S. states, along with the District of Columbia and Puerto Rico, will participate in the Cell and Gene Therapy Access Model, which will help coordinate insurance coverage for these types of treatment. So far, two cell and gene therapies have been approved to treat sickle cell disease, but their high costs have made access difficult for patients. According to CMS, around 50% to 60% of U.S. patients with sickle cell disease have Medicaid coverage, and the states participating in the new model represent roughly 84% of Medicaid beneficiaries with the condition. "This model has the potential to improve health outcomes for patients with sickle cell disease while also ensuring state and taxpayer dollars are being used more effectively," said Abe Sutton, CMS' deputy director and the head of CMS' Innovation Center. (Fidler, Healthcare Dive, 7/16)
• Massachusetts/New York: Private equity firms Bain Capital and Kohlberg are investing billions of dollars in PCI Pharma Services, valuing the company at $10 billion. PCI started as a drug packaging manufacturer, and the company now helps biopharmaceutical companies bring new drugs to the market. Currently, PCI supports 25% of the top 200 drugs, including GLP-1 weight-loss and oncology drugs, and backs over 2,300 drugs currently in development. According to the Wall Street Journal, Kohlberg initially invested in PCI in 2020, working with the Abu Dhabi investment firm Mubadala to take a majority stake in the company. In comparison, this is Bain's first time investing in PCI. Devin O'Reilly, Bain's head of healthcare in North America, said the company believes PCI will benefit from broader trends in the healthcare market, including accelerated drug development through generative AI. (Gottfried, Wall Street Journal, 7/14)
• New York: According to a new report from PwC's Health Research Institute, healthcare costs are expected to increase by up to 8.5% next year. For the report, researchers interviewed actuaries at 24 different health insurers covering 125 million employer-sponsored members and 12 million Affordable Care Act members. Overall, the researchers estimated that healthcare costs would increase by 8.5% in the group market and 7.5% in the individual market. According to PwC, several factors are currently pushing up healthcare costs. One notable example is the One Big Beautiful Bill Act, which includes almost $1 trillion in healthcare cuts and could lead to millions of Americans losing health coverage and increase care costs. Demand for expensive therapies, including GLP-1 weight-loss drugs and cell and gene therapies, and higher short-term costs for AI will also likely contribute to growing healthcare costs going forward. (DeSilva, Modern Healthcare, 7/17)

Four new factors are dramatically increasing employer-sponsored insurance costs. We dissect these for you and offer five care navigation strategies to rein in healthcare spend and a picklist to decide which make the most sense for your organization.