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Stakeholders urge CMS to finalize new CAR-T therapy payment rule

The rule would create a separate hospital payment category for CAR-T therapy, providing predictable payment rates for hospitals.

Mallory Hackett, Associate Editor

A group of patient advocacy groups has sent a letter to the Centers for Medicare and Medicaid Services urging the agency to establish the new Medicare Severity-Diagnosis Related Group for Chimeric Antigen Receptor T-cell Immunotherapy.

In the letter, the stakeholders argued that CAR-T therapies offer improved outcomes for patients with relapsed/refractory diffuse large B-cell lymphoma  and B-cell acute lymphoblastic leukemia and provides hope for many more with other hard-to-treat cancers

The new MS-DRG would also give hospitals and providers a new course of treatment for those cancers.

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The letter backed up its praise with a study in which lymphoma patients had significant improvements in their physical, social and emotional wellbeing following CAR-T therapy.

The organizations signing the letter include the American Cancer Society Cancer Action Network, BMT Infonet, Cancer Support Community, CLL Society, CrowdCare Foundation/Myeloma Crowd, International Myeloma Foundation, Leukemia & Lymphoma Society, Lymphoma Research Foundation, Society for Immunotherapy of Cancer and The Pink Fund.

WHY THIS MATTERS

This letter is a comment to CMS' proposed inpatient prospective payment system rule issued in May.

Under the current rule, CAR-T hospital cases are paid at the same rate as bone marrow transplants and qualify for additional payments through the temporary new technology add-on payment for high-cost cases that are set to expire this year.

The rule would create a separate hospital payment category for CAR-T therapy.

The new MS-DRG for CAR-T would provide predictable payment rates for hospitals administering the therapy.

CAR-T is a gene therapy that uses a patient's own genetically modified immune cells as a treatment for certain types of cancer. This is instead of additional chemotherapy or other types of treatment paid for under the inpatient prospective payment system.

The open comment period for the proposed rule ends today, Friday, July 10.

THE LARGER TREND

For years, organizations such as the American Society for Blood and Marrow Transplantation have been asking for an MS-DRG to be created for CAR-T therapies.

ON THE RECORD

"Our organizations commend CMS for its action and appreciate its forward-leaning policy proposal that will optimize patient access for CAR-T therapy," the stakeholders wrote. "We support finalization of the proposed rule and look forward to working with CMS to further support novel treatments for unmet medical needs among immunotherapy patients."

Twitter: @HackettMallory
Email the writer: mhackett@himss.org