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Statement from ASH President Roy Silverstein, MD, on Medicare Reimbursement for CAR T-Cell Therapy

FY 2020 Inpatient Prospective Payment System final rule does not take all steps needed to help institutions providing potentially curative cell therapies

(WASHINGTON, August 6, 2019) — On Friday the Centers for Medicare and Medicaid Services (CMS) announced it will increase the amount institutions are reimbursed for the product cost of chimeric antigen receptor T-cell (CAR-T) therapy from 50 to 65 percent. ASH had previously called on CMS to increase this payment, which also applies to other new technologies, to 80 percent. 

The change was announced as part of CMS’ FY 2020 Inpatient Prospective Payment System final rule, which applies to more than 3,000 hospitals in the United States. ASH submitted comments to the agency’s proposed rule in June.

2019 American Society of Hematology (ASH) President Roy Silverstein, MD, of the Medical College of Wisconsin issued the following statement: 

“Increasing the amount institutions will be reimbursed for the product cost of CAR-T is a positive step toward making this potentially life-saving therapy more accessible to the patients whose lives it can save. However, we are disappointed that CMS did not take additional steps to address the barriers faced by institutions in recouping the cost of the product as well as the cost of additional medical care these patients require. These requests, which have been outlined in previous comments to CMS, include increasing the new technology add-on payment (NTAP) to 80 percent and instituting a cost-to-charge ratio of 1.0, which would make it easier for institutions to recoup the full NTAP reimbursement. 

Innovative CAR-T therapy represents hope for our blood cancer patients who have exhausted all other treatment options, but only if it is accessible. Some centers are unable to offer CAR-T to Medicare beneficiaries because the overall cost of paying for the treatment and caring for patients, who often must receive care in the intensive care unit, is unsustainable. We must continue to explore new approaches for ensuring patients receive the care recommended by their doctors.

CAR-T is the first of many promising cell and gene therapies that have the potential to revolutionize patient care. The decisions we make today are critical because they will set the precedent for future innovation and access to care. We know CMS recognizes the importance of this moment, and ASH appreciates opportunities to work with the agency to continue to refine the payment structure so that it is sustainable for institutions to administer these cutting-edge therapies.” 

The American Society of Hematology (ASH) (www.hematology.org) is the world’s largest professional society of hematologists dedicated to furthering the understanding, diagnosis, treatment, and prevention of disorders affecting the blood. For more than 50 years, the Society has led the development of hematology as a discipline by promoting research, patient care, education, training, and advocacy in hematology. ASH publishes Blood (www.bloodjournal.org), the most cited peer-reviewed publication in the field, which is available weekly in print and online. In 2016, ASH launched Blood Advances (www.bloodadvances.org), an online, peer-reviewed open-access journal.

Amanda Szabo, American Society of Hematology
[email protected]; 202-552-4914