Aug 8, 2019

Medicare will now cover a costly cell therapy for cancer patients

Caitlin Owens

A lab tech handles a CliniMACS Prodigy automated device used for cell processing. Chimeric antigen receptor (CAR) T-cell therapy has been hailed as a major advance in clinical cancer care. Photo: GERARD JULIEN/AFP/Getty Images

The Centers for Medicare & Medicaid Services announced yesterday that Medicare will cover the innovative but expensive cancer treatment CAR-T, providing "consistent and predictable patient access nationwide," CMS administrator Seema Verma said.

By the numbers: The treatment, which is customized for each individual patient, costs $375,000 or $475,000, depending on the type of cancer, the Washington Post notes. The overall cost can rise by hundreds of thousands of dollars when hospital stays are factored in.

What they're saying: The agency announced last week that it was bumping up what Medicare will reimburse for CAR-T, but it fell short of what hospitals say they need to cover the cost of administering it.

Details: Yesterday's finalized decision contained a win for hospitals, as an earlier proposal would have required them to collect and report patient data over a long time period. Hospitals said this was too burdensome, per the Post.

The decision would also allow CAR-T to be given on an outpatient basis.

Go deeper: CAR-T payment challenges are only beginning

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Medicare will now cover a costly cell therapy for cancer patients

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