Aug 8, 2019 - Health Care

Medicare will now cover a costly cell therapy for cancer patients

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

What's next

Hospitals winning big state battles

Illustration: Aïda Amer/Axios

Several states have made ambitious attempts to address health care costs, only to be thwarted by the hospital industry.

Why it matters: States' failures provide a warning to Washington: Even policies with bipartisan support — like ending surprise medical bills — could die at the hand of the all-powerful hospital lobby.

The plight of America's rural health care

Illustration: Sarah Grillo/Axios

Rural America is stuck in a cycle of increasingly vulnerable patients with declining access to health care.

Why it matters: Rural patients often can't afford care, are being hounded by hospitals and collection agencies over their unpaid bills, and are facing the reality of life in communities where the last hospital has closed.

Hospital care is getting more expensive for Americans

Hospital prices for inpatient services increased more than the prices paid to doctors providing these services between 2013 and 2017, according to a new data brief by United Health Group.

By the numbers: Hospital prices for inpatient services increased by 19% over this time period, or by 4.5% per year. Physician prices for inpatient services increased by 10%, or 2.5% per year.