CMS proposed a payment increase for hospitals administering CAR-T therapy treatments in response to criticism that CAR-T costs aren't sustainable for hospitals, STAT reported.
CAR-T therapy is a breakthrough therapy that uses patients' immune cells to treat certain advanced blood cancers. The therapy is very expensive and can have a list price of $450,000 per patient.
The pharmaceutical industry, patients advocates and hospitals have said Medicare's low reimbursement rates for CAR-T therapies have forced hospitals to choose between losing money or not giving the therapy to patients at all, STAT reported.
Under the current reimbursement system, hospitals are losing about $50,000 per patient every time they administer a CAR-T therapy, according to an analysis from the American Action Forum cited by STAT.
Medicare bases its reimbursement rates for CAR-T on the average cost for a complicated bone marrow transplant, an amount far lower than what CAR-T therapies actually cost.
The new proposed payment policy would reimburse hospitals for CAR-T drugs based on the average price of the two CAR-T therapies currently on the market, Gilead's Yescarta, a non-Hodgkin lymphoma treatment, and Novartis' Kymriah, a leukemia treatment.
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