CAR-T therapies have emerged as promising new cancer treatments with shockingly high price tags. However, under a new proposal released by CMS Feb. 15, Medicare would pay for the therapies for patients across the nation.
The proposal specifies that Medicare will cover all FDA-approved CAR-T therapies so long as patients meet clinical requirements and are enrolled in a program that tracks their outcomes.
Under the proposal, patients would be required to have a relapsed form of cancer and could not have another condition that would hinder the benefits of CAR-T therapy.
CMS didn't propose changes to the amount Medicare would pay for the treatments. It now reimburses hospitals for up to half the price of the drug itself and some associated costs of treatment.
The nationwide proposal is key for the drugmakers investing in the therapy because private insurers look to Medicare to inform their own coverage decisions. It also would help standardize coverage across the U.S. Currently, private companies that often run state Medicare programs can decide whether or not to cover the drug.
Drugmakers, insurers and other healthcare stakeholders can comment on the proposal for 30 days.