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.
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