A biologist works on immunotherapy for HPV+ cancers at the National Cancer Institute. Photo: Saul Loeb/AFP/Getty Images

The Centers for Medicare & Medicaid Services issued a proposed rule yesterday addressing Medicare hospital payments in 2020, including how hospitals will be reimbursed for CAR-T therapies.

The big picture: These are medical procedures that use a patient's own cells to fight cancer — a treatment that also comes with a high price tag.

Details: The proposed rule narrows the gap between what Medicare pays for CAR-T and what the drug companies that make it charge, but there's still a substantial gap.

By the numbers: Hospitals can lose upwards of $100,000 when they administer CAR-T therapies to Medicare beneficiaries today, because of the way payment is structured.

  • The 2 CAR-T therapies on the market have a price tag of $373,000 per procedure.
  • Right now, hospitals receive varying payment rates, which can include an add-on of up to 50% of the manufactures' price, or $186,500. Yesterday's proposal increases that add-on to 65%, or $242,450.

Between the lines: Hospitals would obviously rather be made whole for the cost of the procedure. There'd been talk of increasing the base payment by creating a new billing code for CAR-T, but CMS decided not to do that, at least not yet.

  • Outpatient reimbursement for the procedure is much more generous, as it's structured completely differently, but comes with added risk.

CMS is also considering raising Medicare rates to hospitals by 3.7% on average next year, by far the largest proposed pay hike in several years. Penalties for too many readmissions or poor quality will be opportunities for wiggle room in the Medicare price hike.

Go deeper: Stat News dug into hospitals' payment dilemma in March.

— Correction: An earlier version of this story said hospitals all get paid the same amount for CAR-T therapy. That's incorrect. Their payments vary.

Go deeper

Trump pushes to expand ban against anti-racism training to federal contractors

Trump speaking at Moon Township, Penns., on Sept. 22. Photo: Mandel Ngan/AFP via Getty Images

President Trump announced late Tuesday that the White House attempt to halt federal agencies' anti-racism training would be expanded to block federal contractors from "promoting radical ideologies that divide Americans by race or sex."

Why it matters: The executive order appears to give the government the ability to cancel contracts if anti-racist or diversity trainings focused on sexual identity or gender are organized. The memo applies to executive departments and agencies, the U.S. military, federal contractors and federal grant recipients.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 9:30 p.m. ET: 31,467,508 — Total deaths: 967,881— Total recoveries: 21,583,915Map.
  2. U.S.: Total confirmed cases as of 9:30 p.m. ET: 6,890,662 — Total deaths: 200,710 — Total recoveries: 2,646,959 — Total tests: 96,612,436Map.
  3. Health: The U.S. reaches 200,000 coronavirus deaths — The CDC's crumbling reputation — America turns against coronavirus vaccine.
  4. Politics: Elected officials are failing us on much-needed stimulus.
  5. Business: Two-thirds of business leaders think pandemic will lead to permanent changes — Fed chair warns economy will feel the weight of expired stimulus.
  6. Sports: NFL fines maskless coaches.
Dan Primack, author of Pro Rata
3 hours ago - Economy & Business

GoodRx prices IPO at $33 per share, valued at $12.7 billion

Illustration: Sarah Grillo/Axios

GoodRx, a price comparison app for prescription drugs at local pharmacies, on Tuesday night raised $1.14 billion in its IPO, Axios has learned.

By the numbers: GoodRx priced its shares at $33 a piece, above its $24-$28 per share offering range, which will give it an initial market cap of around $12.7 billion.

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