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Gary Puckrein sees a dilemma coming that has him excited, and at the same time, worried.

In the next year or so, U.S. regulators may approve gene therapies – from Vertex Pharmaceuticals and Bluebird Bio – to treat sickle cell disease, an inherited group of blood disorders that affect an estimated 100,000 Americans. The condition is particularly prevalent among Black people, with 1 of every 365 Black individuals in the U.S. born with the condition, which can cause significant pain, infections, and lead to an early death.

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Any treatment would be welcome news, especially since a gene therapy holds the promise of eradicating the illness with potentially just one treatment. But gene therapies are widely expected to come with a high price tag — and it’s estimated that roughly 40% of sickle cell patients are covered by Medicaid. That is raising concern that state Medicaid officials may soon face a struggle for coverage.

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