Medicare Weighing Higher Add-On Payments For New Drugs, Including CAR-T
Change would increase maximum new technology add-on payments from 50% to 65% of costs.
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Roche's Richard Peck says adoption of outcomes-based pricing in the US could be powerful incentive to study precision dosing, although he also calls on drugmakers to put out scientific examples.
US Centers for Medicare and Medicaid Services concludes structural changes to existing payment systems to accommodate the high cost of Novartis’ Kymriah and Gilead’s Yescarta are still “premature.”
Biopharma firms and providers argue that CMS's current approach to awarding Medicare new technology add-on payments for CAR-T treatment is not suited to the high-cost therapy and is leading some hospitals to mark up billed charges substantially so they can get as much supplemental reimbursement as possible.