Medicare Raises Payments for CAR-T Therapies

It moves the reimbursement rate to hospitals from 50% to 65% of the costs.

Medicare’s decision to reimburse more of the cost of CAR-T therapies to hospitals for expensive new cancer treatments helps a little, hospital officials say, but doesn’t go nearly far enough. Joseph Alvarnas, an oncologist at the City of Hope Comprehensive Cancer Center, tells the Washington Post (in a response the newspaper described as “muted”) that “for now, this should probably be viewed as a step forward, but an incremental (rather than decisive) one.”

The list price for CAR-T is $373,000 per treatment. The move by CMS last week raises the amount Medicare will pay for beneficiaries with lymphoma getting CAR-T from $186,000 to $240,000.

Only some hospitals will be able to afford to offer the therapy, Jayson Slotnik, a partner at Health Policy Strategies, a consulting firm, tells the newspaper, and some provider groups and CAR-T manufacturers would like Medicare to pay 80% to 100% of the cost.

However, the Post reports, “the Leukemia & Lymphoma Society said it was ‘very pleased’ by the CMS decision. The American Hospital Association said the change will provide ‘some much-needed short-relief’ but further long-term solutions are needed.”