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When Bluebird Bio secured European approval for its gene therapy to treat beta thalassemia in 2019, the biotech entered pricing negotiations confident that a “shared risk” plan could convince governments to pay $1.8 million per patient for the one-time, potentially curative treatment.

But two years later, Bluebird is pulling its gene therapy, called Zynteglo, from Germany after government officials would not budge from an offer to pay less than half of the company’s list price. The stalemate is a significant setback for Bluebird’s business ambitions in Europe, but it also raises broader questions about whether Europe can ever become a viable commercial market for other expensive gene therapies.

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