A cure for CAR T reimbursement

September 4, 2020
Before you log off for the holiday weekend, we have the scoop on a new rule that will help ensure patients have access to the latest transformative therapies, as well as a look at how biotech is improving your last summer cookout of the season. Here are 790 words, just…

Before you log off for the holiday weekend, we have the scoop on a new rule that will help ensure patients have access to the latest transformative therapies, as well as a look at how biotech is improving your last summer cookout of the season. Here are 790 words, just under 4 minutes. 

Good Day BIO is taking a quick break for Labor Day. We’ll be in touch if there’s major breaking news, but otherwise, we’ll resume regular publication on Tuesday, September 8.

A cure for CAR T reimbursement

Centers for Medicare and Medicaid Services (CMS) finalized a rule this week providing a new payment group for CAR T-cell therapy—something we and our members have wanted, and something that will set the stage for coverage of other transformative medicines in the pipeline, too. 

This week, CMS announced the Fiscal Year (FY) 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS), the “final rule for acute care and long-term care hospitals that ensures access to potentially life-saving diagnostics and therapies by unleashing innovation in medical technology and removing barriers to competition,” per the press release.

The rule includes a new diagnosis-related group (DRG) for CAR T-cell therapy, which will streamline reimbursement for providers administering it to patients with cancer.   

Remind me, what’s CAR T? Chimeric antigen receptor (CAR) T-cell immunotherapy is a powerful cancer treatment that uses “the patient’s own immune cells to help them take on cancer,” as RealClearHealth put it in February, with gentler side effects than chemotherapy and radiation. 

Why it matters: Medicare had been covering the treatment with a new technology add-on payment (NTAP), which was due to expire on September 30, 2020. The expiration would have left hospitals with inadequate payment rates for the therapy, making it more difficult for America’s seniors to access it. 

Dan’s Deep Dive: This final rule reaffirms the many benefits transformational therapies—such as CAR T-cell therapy—provide patients and society more broadly. Medicare reimbursement should not serve as a barrier to life-saving treatments, and the final policy announced today validates this basic principle. It’s vital the Trump administration continue to build on these steps to ensure that seniors benefit from the next generation of innovative cures and treatments, including CAR T-cell therapy. – Dan Durham, BIO’s EVP for Health Policy 

P.S. In need of a good podcast for the long weekend? Check out this recent conversation between BIO’s Dr. Michelle McMurry-Heath and Halloran Consulting’s Laurie Halloran and Hannah Yee, in which they talk about diversity in the health care industry, why science is a social justice issue, and the BIOEquality Agenda.  


More Health Care News: 

BioCentury: BIO leaders urge industry to hew to norms for COVID-19 candidates
“If we do not allow and encourage the primacy of science and medicine in the assessment of these vaccines, then we will never be able to deal with the next pandemic, and that will be a real threat to America,” BIO Chair Dr. Jeremy M. Levin told BioCentury. 

Biopharma Dive: Sanofi, GSK, racing to catch up, begin first human study of coronavirus vaccine
“[T]he two are using a more established vaccine technology that they argue could deliver a more potent shot. The U.S. government has promised up to $2.1 billion in funding for the program.” 

USA Today (Opinion): How we're developing a COVID-19 vaccine at 'Warp Speed'
“The strategy we devised for [Operation Warp Speed] will allow us to accomplish this goal while following all the same procedures for safety and efficacy, applied by the same apolitical FDA experts, that Americans expect with all vaccines,” says U.S. Secretary of Health and Human Services Alex Azar.


How biotech is improving the Labor Day spread

Even though it may feel like March 187th, believe it or not, it’s Labor Day weekend. If you’re taking advantage of summertime food classics one last time before pumpkin spice really takes hold, you have biotech to thank, says BIO’s Connor McKoy.

Firing up the grill with Impossible Burgers? Thank biotech. “The ingredient that makes this burger taste like the real thing is genetically engineered heme—short for hemoglobin,” he explains.

Why Biotech? “We’ve always embraced the responsible, constructive use of genetic engineering to solve critical environmental, health, safety and food security problems and have long advocated for responsible use of this technology in the food system," says Impossible Foods.

Biotech has helped your side of corn on the cob, too. “Advances in genetic modification have improved several corn varieties so they tolerate warmer weather, use water more efficiently, and are able to withstand damaging insects and diseases," continues Connor. 

How about an all-American apple pie to finish? Thanks to genetic modification, Okanagan Specialty Fruits’ Arctic Apple doesn’t bruise or turn brown when sliced.  

And that’s not all. Researchers are exploring how to improve the tomato, the onion, and the peach, ensuring we’ll be able to enjoy these foods for summers to come. 

Read the whole thing.

Learn more about advances in gene editing to benefit our food.

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BIO Beltway Report

President Trump’s Friday: Hosting the President of the Republic of Serbia and the Prime Minister of the Republic of Kosovo at the White House for economic talks. Here's some context.

What’s Happening on Capitol Hill: Enjoy the holiday weekend—and if you have some down time, it’s a good opportunity to visit www.bio.org/vote to learn how to check your voter registration status and make sure you're ready for Election Day.

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