Medicare will begin to cover CAR T-cell therapies in some facilities

Published on fiercehealthcare.com

Medicare will begin covering the growing collection of immunotherapy drugs referred to as CAR T-cell therapy for cancer patients being treated in some healthcare facilities, the Centers for Medicare & Medicaid Services announced Wednesday.

A growing number of drug companies have begun seeking and achieving regulatory approval for chimeric antigen receptor (CAR) T-cell therapy, in which oncologists use a patient’s own immune system to attack certain cancers. Food and Drug Administration-approved CAR T-cell therapies have been OK’d to treat some people with specific types of cancer including certain types of non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia.

“In the absence of a national coverage decision, basically, hospitals and providers are going to our Medicare contractors, or MACs, and are making these decisions. There’s a lot of confusions about ‘Is this covered? How is it covered?'” CMS Administrator Seema Verma said in a call with reporters. “Today’s decision makes it very clear that ‘Yes, this is covered.’ We’re paying that not only for CAR T, but all the related services. The administration of the drug. The collection of the cells. The manipulation of the cells and then putting it back into the patient. And then any of their outpatient or inpatient care as well.”

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