CAR-T Reimbursement: Medicare Weighing Bundle For Kymriah, Yescarta In 2019
Otherwise, CMS proposes pegging inpatient hospital reimbursement for CAR-T treatment to bundled rate for bone marrow transplants and potentially providing add-on payments for at least a couple of years.
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CMS determines in final hospital inpatient rule that it will reimburse CAR-T drugs under an existing Medicare payment bundle supplemented by add-on payments.
Potentially curative regenerative medicine therapies are no longer theoretical, but instead have become reality. As more and more gene, cell and tissue-based therapies reach the market, the need for payment solutions is becoming more pressing. The Alliance for Regenerative Medicine has consulted with payers and other stakeholders to consider the barriers to alternative payment models and look at possible solutions.
With 15 new gene and cell-based therapies in late-stage testing, the time is now to consider a critical strategic question: is there a pricing model for these budget-busting treatments that works in both safeguarding returns to innovators and providing access to patients at a price society is willing to pay? An analysis by ZS Associates looks at the options for biopharma going forward.