The Centers for Medicare and Medicaid Services (CMS) proposed a new system for calculating reimbursement rates for hospitals administering chimeric antigen receptor T-cell (CAR-T) therapies.
Under the new policy, CMS would reimbursement hospitals that provide CAR-T therapies based on the average price of the 2 therapies currently available for patients, axicabtagene ciloleucel (Yescarta, Gilead) and tisagenlecleucel (Kymriah, Novartis).
This new policy was proposed as a part of the 2021 Inpatient Prospective Payment System (IPPS) regulation, a regulation which sets Medicare reimbursement policies.
The current basis for CMS reimbursement for CAR-T therapies is the average cost of administering a bone marrow transplant. A 2017 study found that the median cost of a bone marrow transplant is between $150,000 and $300,000, dependent on the patients’ diagnosis. However, the list prices of CAR-T therapies exceed $450,000 per patient.
This new policy, if finalized, would affect only patients who received Medicare coverage. Although, private insurance providers may use the federal guidelines as a model for setting their own payment rates in the future.
The IPPS rulings are expected to be finalized in the fall of 2020.—Janelle Bradley
Source: STAT. Trump administration proposes a dramatic payment boost for CAR-T treatments under Medicare. May 12, 2020. https://www.statnews.com/2020/05/12/medicare-car-t-boost/. Accessed August 24, 2020.
