CAR-T In Medicare: Add-On Payments But No New Bundle Planned For 2019
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.
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Change would increase maximum new technology add-on payments from 50% to 65% of costs.
Novartis and Gilead longer-term data show largely steady response and survival rates, shoring up the clinical and commercial case for their products and justifying continued investment in T-cell therapies. The CAR-T pioneers discuss their progress, including with allogeneic platforms, with Scrip at ASH.
Medicare’s current approach to inpatient CAR-T reimbursement in 2019 would lead to an $186,500 shortfall for providers per patient, stakeholders estimate.