Medicare and Medicaid Increases CAR T Coverage for Multiple Myeloma Treatment

CAR T therapy is an emerging treatment for multiple myeloma and over 70% of myeloma patients are on Medicare or Medicaid. CAR T treatments are usually a single-dose administration and are expected to be expensive.

Last Friday, the the Centers for Medicare and Medicaid Services (CMS) announced it will increase the amount institutions are reimbursed for the product cost of chimeric antigen receptor T-cell (CAR-T) therapy from 50 to 65 percent.

The American Society of Hematology (ASH) organization had previously requested that CMS increase coverage of CAR T therapy and other newer technologies to 80 percent.

The change was announced as part of the CMS 2020 Inpatient Prospective Payment System final rule which applies to over 3,000 hospitals in the United States.

ASH 2019 President Roy Silverstein, MD of the Medical College of Wisconsin said:

“Increasing the amount institutions will be reimbursed for the product cost of CAR-T is a positive step toward making this potentially life-saving therapy more accessible to the patients whose lives it can save. However, we are disappointed that CMS did not take additional steps to address the barriers faced by institutions in recouping the cost of the product as well as the cost of additional medical care these patients require. 

Innovative CAR-T therapy represents hope for our blood cancer patients who have exhausted all other treatment options, but only if it is accessible. Some centers are unable to offer CAR-T to Medicare beneficiaries because the overall cost of paying for the treatment and caring for patients, who often must receive care in the intensive care unit, is unsustainable. We must continue to explore new approaches for ensuring patients receive the care recommended by their doctors.

CAR-T is the first of many promising cell and gene therapies that have the potential to revolutionize patient care. The decisions we make today are critical because they will set the precedent for future innovation and access to care. We know CMS recognizes the importance of this moment, and ASH appreciates opportunities to work with the agency to continue to refine the payment structure so that it is sustainable for institutions to administer these cutting-edge therapies.”