Breakthrough personalized medical treatment, such as CAR T-cell therapy, is truly “the future of medical progress,” as RealClearHealth put it in an important op-ed last week—but we must make sure patients can access this treatment, and future treatments like it.
Remind me, what’s CAR T? Chimeric antigen receptor (CAR) T-cell immunotherapy is a cancer treatment in which “the patient’s own immune cells to help them take on cancer,” as RealClearHealth puts it.
And it’s been incredibly successful in treating certain blood cancers, with gentler side effects than other treatments like chemotherapy, radiation, and surgery.
Why are we talking about it now? Currently, the Centers for Medicare and Medicaid Services (CMS) covers the treatment with a new technology add-on payment (NTAP), but this expires on September 30, 2020. Without further action by CMS, there will be no permanent mechanism to cover the therapy for America’s seniors.
What they’re saying: “The therapy is astonishing. However, without appropriate reimbursement policy, a Medicare patient could be denied access to a treatment that would save his or her life. Without proper reimbursement by Medicare, providers simply will not be able to offer it as an option, especially in rural areas as patients must stay near a treatment center for four weeks to be monitored,” explain the RealClearHealth editors.
And 76 Members of Congress agree. They sent a letter to ask CMS to “ensure that hospitals are appropriately reimbursed” for the therapy, by establishing a Medicare Severity-Diagnosis Related Group, or MS-DRG, for it.
Why it matters: A specific payment rule for CAR T will not only help patients obtain this breakthrough treatment, but it will also serve as a model for how we reimburse future transformative medicines in the pipeline that have the ability to change the way we treat and cure our world’s deadliest and most debilitating diseases.
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