ASBMT, the American Society of Hematology, the American Cancer Society-Cancer Action Network, the Leukemia and Lymphoma Society, the Lymphoma Research Foundation and the Personalized Medicine Coalition sponsored a journalist briefing on CAR-T on November 16 in Washington, D.C. A patient shared his experience receiving CAR-T at the University of Maryland and how the procedure saved his life when he had exhausted treatment options. His doctor, Dr. Aaron Rapaport, gave a presentation on the mechanics of CAR-T and discussed the process that the University of Maryland recently completed to become a Yescarta-certified facility.
Meghan Gutierrez from the Lymphoma Research Foundation spoke about CMS’ National Coverage Analysis and the impact on patient’s access to care. She also noted that while FDA has currently approved only two products, hundreds more are in clinical trials and it is imperative that the reimbursement system be able to cover these products when they come to market.
Jugna Shah, President of Nimitt Consulting Inc. and reimbursement advisor to ASBMT, provided an excellent presentation on Medicare’s current inpatient reimbursement policies for CAR-T. She walked participants through a case study of two hospitals treating CAR-T patients to demonstrate that even with the New Technology Add-On (NTAP) and additional outlier payment Medicare’s payment for CAR-T therapy to hospitals is severely inadequate resulting anywhere from tens to hundreds of thousands of dollars in losses per case. One aim of her presentation was to shine a light on the financial risks that hospitals and providers are having to take on in order to provide access to CAR-T therapy to patients in need under the current Medicare inpatient reimbursement system. She also highlighted the joint letter that ASBMT and ASH recently sent to CMS Administrator Verma with both short and long-term recommendations to improve reimbursement; the letter was also made available to the briefing attendees and is available on the ASBMT website.
“It was great to see ASBMT engaged in a one-two punch, so to speak, working hard to engage and inform Hill staff of the reimbursement problems and the required solutions, as well as the media, so everyone has a better understanding of the technical reimbursement formulas as well as the significant operational and financial concerns hospitals are facing,” Shah said after the event.