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Costly CAR T-cell therapy gets boost with Medicare proposal to increase reimbursements

| | April 29, 2019

Medicare officials on [April 23] proposed increasing reimbursements for a groundbreaking but costly cancer therapy used for patients whose blood cancers don’t respond to other treatments.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said the proposed changes are necessary because “Medicare’s antiquated payment systems” have not kept up with the development of “transformative technologies.” She said she is concerned inadequate payments might be prompting hospitals to limit Medicare patients’ access to needed therapies.

In particular, she said the agency was considering boosting reimbursements for a customized approach called CAR T-cell therapy, which has revolutionized the treatment of hard-to-treat pediatric leukemia and adult lymphoma. Hospitals have complained vociferously that they lose tens of thousands of dollars — and in some cases, hundreds of thousands — on each Medicare patient they treat.

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In a press call with reporters, Verma said the agency is considering increasing a special payment to hospitals for expensive new technologies from the current maximum of 50 percent to 65 percent of the product’s cost. That would boost payments for CAR T-cell therapy from $186,500 to $242,450.

Read full, original post: Medicare proposes higher payments for innovative cancer treatment

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