2. Hospitals seek CAR-T pay bump from Medicare
Cancer hospitals have been lobbying Medicare to create a new set of enhanced payments for CAR-T cell therapy, Axios’ Bob Herman reports this morning.
The details: CAR-T is a promising but very expensive new treatment that fights cancer cells using patients’ own immune systems. Two CAR-T therapies have been approved; the cheaper one has a list price of $373,000, and the other is $475,000.
- Medicare has already approved a payment bump for CAR-T therapies in outpatient settings, but not for inpatient treatment. And hospitals are only comfortable providing the drugs in inpatient settings, because the products are new and require intensive monitoring.
- Many hospitals "would like to start the program, but not without adequate reimbursement from Medicare," one person familiar with the issue told Bob.
The intrigue: Four lobbyists representing cancer hospitals met in February with senior officials, including Demetrios Kouzoukas, a top Medicare director in the Trump administration, to discuss a payment bump for CAR-T.
What’s next: Medicare releases a big regulation each April on inpatient payment policies. That’s expected any day now, and we’ll see whether CAR-T gets an “add-on” payment.