CMS Expands Coverage of CAR T-Cell Therapy for Medicare Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) released a new national coverage determination (NCD) announcing that Medicare will now cover U.S. Food and Drug Administration (FDA)-approved chimeric antigen receptor T-cell (CAR T-cell) therapy for certain patients with cancer.
As outlined in the NCD, Medicare will now:
- Cover CAR T-cell therapies nationwide
- Provide coverage when CAR T-cell therapy is administered in inpatient facilities or in outpatient health-care facilities that are enrolled in FDA risk evaluation and mitigation strategies with expertise in delivering cellular therapies
- Cover CAR T-cell therapy for off-label uses that are recommended by CMS-approved compendia.
CAR T-cell therapy uses a patient’s own white blood cells, which have been genetically reprogrammed, to fight specific cancer cells. In 2017, the FDA approved two CAR T-cell therapies to treat children and young adults with acute lymphoblastic leukemia and adults with diffuse large B-cell lymphoma. Researchers are also pursuing this approach in other types of cancer, with promising results—especially in multiple myeloma. ASCO named CAR T-cell therapy the “Advance of the Year” in Clinical Cancer Advances 2018.
Howard A. “Skip” Burris III, MD, FACP, FASCO
“ASCO applauds CMS for releasing an NCD on CAR T-cell therapy that provides increased access to an innovative cancer treatment to Medicare beneficiaries nationwide,” said ASCO President Howard A. “Skip” Burris III, MD, FACP, FASCO. “The determination is largely consistent with ASCO’s principles for CAR T-cell therapy coverage, which support coverage for all FDA-approved indications of this treatment.”
Earlier this month, CMS released the Hospital Inpatient Prospective Payment System final rule for fiscal year 2020, which included a new technology add-on payment (NTAP) for 18 technologies, including CAR T-cell therapy.
In comments submitted to CMS in June 2019, ASCO outlined its principles for the approval, coverage, and reimbursement of CAR T-cell coverage and urged CMS to establish an NTAP of at least 80%.
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