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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

23 mins ago - World

Iran's nuclear dilemma: Ramp up now or wait for Biden

Illustration: Annelise Capossela/Axios

The world is waiting to see whether Iran will strike back at Israel or the U.S. over the assassination of Mohsen Fakhrizadeh, the architect of Iran's military nuclear program.

Why it matters: Senior Iranian officials have stressed that Iran will take revenge against the perpetrators, but also respond by continuing Fakhrizadeh’s legacy — the nuclear program. The key question is whether Iran will accelerate that work now, or wait to see what President-elect Biden puts on the table.

Updated 1 hour ago - Health

U.K. first nation to clear Pfizer coronavirus vaccine for mass rollout

A health care worker during the phase 3 COVID-19 vaccine trial by Pfizer and BioNTech in Ankara, Turkey, in October. Photo: Dogukan Keskinkilic/Anadolu Agency via Getty Images

The United Kingdom's government announced Wednesday it's approved Pfizer-BioNTech's COVID-19 vaccine, which "will be made available across the U.K. from next week."

Why it matters: The U.K. has beaten the U.S. to become the first Western country to give emergency approval for a vaccine that's found to be 95% effective with no serious side effects against a virus that's killed nearly 1.5 million people globally.

3 hours ago - World

Biden says he won't immediately remove U.S. tariffs on China

President-elect Joe Biden during an event in Wilmington, Delaware, on Tuesday. Photo: Alex Wong/Getty Images

President Trump's 25% tariffs imposed on China under the phase one trade deal will remain in place at the start of the new administration, President-elect Biden said in an interview with the New York Times published early Wednesday.

Details: "I'm not going to make any immediate moves, and the same applies to the tariffs," Biden said. He plans to conduct a full review of the current U.S. policy on China and speak with key allies in Asia and Europe to "develop a coherent strategy," he said.