BY VIRGIL DICKSON | MAY
17, 2018
The CMS is considering reimbursing all Medicare providers for
one-time cancer treatments that genetically alter patients' cells to fight the
disease. The move could increase revenue by millions at each hospital offering
the therapy.
The FDA cleared two forms of chimeric antigen receptor-T or
CAR-T therapies last year for patients battling leukemia and
lymphoma. Novartis and Gilead manufacture the two cell therapies marketed as
Kymriah and Yescarta. The treatments, which are meant to be a one-time event,
work by manipulating immune cells to attack cancer cells.
While local Medicare contractors can cover CAR-T treatments
already, there is no national payment policy to reimburse hospitals which
typically administer the treatments. The CMS pays hospitals $500,839 for
administering Kymriah and $395,380 for Yescarta. Hospitals also can secure more
revenue from inpatient stays stemming from the treatment's side effects. The patient
then also undergoes chemotherapy and if complications arise, might need to be
hospitalized.
The total bill could add up to $1.5 million per patient, between actual treatment costs and
inpatient stays.
UnitedHealthcare urged the CMS to cover the treatments nationally via a letter to the agency earlier this year.
"We believe there is an industry-wide need for a national coverage determination to ensure a level playing field across Medicare Advantage plans," UnitedHealthcare said. "Absent a national coverage determination providers and beneficiaries could get inconsistent treatment decisions and inconsistent Medicare Administrative Contractors decisions."
The CMS will accept comments through June 15 on the request. The agency also will host an advisory committee meeting to discuss the proposal on Aug. 22.
The CMS said it is concerned about the lack of research about whether Medicare enrollees use CAR-T therapy. That could pose a barrier to national coverage. It also raised concerns about adverse event rates.
The CMS anticipates that it will release a proposed coverage decision by Feb. 16, 2019, and a final decision by May 17, 2019.
UnitedHealthcare urged the CMS to cover the treatments nationally via a letter to the agency earlier this year.
"We believe there is an industry-wide need for a national coverage determination to ensure a level playing field across Medicare Advantage plans," UnitedHealthcare said. "Absent a national coverage determination providers and beneficiaries could get inconsistent treatment decisions and inconsistent Medicare Administrative Contractors decisions."
The CMS will accept comments through June 15 on the request. The agency also will host an advisory committee meeting to discuss the proposal on Aug. 22.
The CMS said it is concerned about the lack of research about whether Medicare enrollees use CAR-T therapy. That could pose a barrier to national coverage. It also raised concerns about adverse event rates.
The CMS anticipates that it will release a proposed coverage decision by Feb. 16, 2019, and a final decision by May 17, 2019.
No comments:
Post a Comment