[Ip-health] Cancer hospitals push for Medicare CAR-T payments

Claire Cassedy claire.cassedy at keionline.org
Wed Apr 18 07:45:15 PDT 2018


Cancer hospitals push for Medicare CAR-T payments

Bob Herman - April 18, 2018

Lobbyists representing cancer hospitals are urging Medicare officials to
create a new set of payments for new, expensive CAR-T treatments.

Looking ahead: Medicare is expected to release a big annual payment rule
any day now, and there's a chance it could propose "add-on" payments for
CAR-T therapies — a move that would cost the government millions of dollars
while immediately broadening dying cancer patients' access to promising new

The details: Federal meeting records show four lobbyists working on behalf
of cancer hospitals like Memorial Sloan Kettering Cancer Center and MD
Anderson met with Medicare officials in February — including Demetrios
Kouzoukas, a top Medicare director in the Trump administration — to talk
about the proposed inpatient payment rule that is released every April.

Specifically, they discussed Medicare's payment policies for CAR-T, a
therapy that attacks cancer by using a patient's own immune cells. Two
CAR-T treatments have gotten FDA approval:

   - Kymriah, made by Novartis, has a list price of $475,000.
   - Yescarta, made by Gilead Sciences, has a list price of $373,000.

The rub: Medicare has approved outpatient rates for CAR-T at the standard
price plus 6%, but the cost of inpatient CAR-T treatments is rolled into
smaller bundled amounts that encompass the entire hospitalization.

Why it matters: Cancer doctors have only been comfortable providing CAR-T
on an inpatient basis because the treatment is still new and patients need
to be monitored closely for adverse reactions.

   - Many hospitals "would like to start the program, but not without
adequate reimbursement from Medicare," said one person familiar with the
industry, adding that Medicare officials "know it's a problem."

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