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Memorial Sloan Kettering Cancer Center in New York City. Photo: Smith Collection / Gado via Getty Images

Lobbyists representing cancer hospitals are urging Medicare officials to create a new set of payments for new, expensive CAR-T treatments.

Looking ahead: Medicare is expected to release a big annual payment rule any day now, and there's a chance it could propose "add-on" payments for CAR-T therapies — a move that would cost the government millions of dollars while immediately broadening dying cancer patients' access to promising new treatments.

The details: Federal meeting records show four lobbyists working on behalf of cancer hospitals like Memorial Sloan Kettering Cancer Center and MD Anderson met with Medicare officials in February — including Demetrios Kouzoukas, a top Medicare director in the Trump administration — to talk about the proposed inpatient payment rule that is released every April.

Specifically, they discussed Medicare's payment policies for CAR-T, a therapy that attacks cancer by using a patient's own immune cells. Two CAR-T treatments have gotten FDA approval:

  • Kymriah, made by Novartis, has a list price of $475,000.
  • Yescarta, made by Gilead Sciences, has a list price of $373,000.

The rub: Medicare has approved outpatient rates for CAR-T at the standard price plus 6%, but the cost of inpatient CAR-T treatments is rolled into smaller bundled amounts that encompass the entire hospitalization.

Why it matters: Cancer doctors have only been comfortable providing CAR-T on an inpatient basis because the treatment is still new and patients need to be monitored closely for adverse reactions.

  • Many hospitals "would like to start the program, but not without adequate reimbursement from Medicare," said one person familiar with the industry, adding that Medicare officials "know it's a problem."

Go deeper: Bloomberg profiled CAR-T insurance hurdles in December.

Go deeper

Updated 59 mins ago - Health

Texas to end all coronavirus restrictions

Texas Gov. Greg Abbott speaking at the White House in December 2020. Photo: Al Drago/Bloomberg via Getty Images

Texas will end its coronavirus restrictions next week with an upcoming executive order, Gov. Greg Abbott (R) announced Tuesday during a press conference in Lubbock.

Why it matters: After Abbott signs the new order, which rescinds previous orders, all businesses can open to 100% capacity and the statewide mask mandate will be over, though large parts of the state will remain under mask local ordinances.

Senate confirms Rhode Island Gov. Gina Raimondo as commerce secretary

Rhode Island Gov. Gina Raimondo (D). Photo: David L. Ryan/The Boston Globe via Getty Images

The Senate voted 84-15 on Tuesday to confirm Rhode Island Gov. Gina Raimondo to lead the Commerce Department.

Why it matters: The agency promotes U.S. industry, oversees the Census Bureau, plays a key role in the government's study of climate change through the National Oceanic and Atmospheric Administration, and evaluates emerging technology through the National Institute of Standards and Technology.

Updated 1 hour ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

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  2. Axios-Ipsos poll: Americans' hopes rise after a year of COVID
  3. Vaccine: J&J CEO "absolutely" confident in vaccine distribution goals — Vaccine hesitancy is shrinking.
  4. World: China and Russia vaccinate the world, for now.
  5. Energy: Global carbon emissions rebound to pre-COVID levels.
  6. Local: Florida gets more good vaccine newsMinnesota's hunger problem grows amid pandemic — Denver's fitness industry eyes a pandemic recovery.