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Proposed Changes to Reimbursement to Help Pay for CAR-T Therapy for Patients Covered by Medicare or Medicaid

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May 15, 2020

CAR-T is an essential new treatment opportunity for patients. In my personal experience, I have no measurable leukemia two years after completing my CAR-T clinical trial in Seattle.

As of today, my fellow CLL patients can only access CAR-T treatment through a clinical trial, as it is not yet approved for our blood cancer.

However, for patients with certain types of lymphoma, and for children and young adults with acute lymphoblastic leukemia (ALL), CAR-T is already an approved and very effective option.

However, finding a medical center that both provides the procedure and accepts patients for CAR-T with Medicare or Medicaid insurance can be challenging, as hospitals lose money on these patients due to inadequate reimbursement.

The CLL Society, along with other blood cancer charities, has been advocating to change this for over a year now.

Early this week, CMS, the agency that determines the reimbursement schedule for government insurance, proposed a new and more generous payment for CAR-T, which should improve the situation.

This proposed increase in CAR-T reimbursement does not, however, apply to clinical trials, so these proposed benefits would not extend to CLL at this time. Regardless, we at the CLL Society see this as a positive move for our fellow blood cancer patients.

The CLL Society supports responsible policies that adequately pay for CAR-T to ensure that hospitals do not have to limit access in order to prevent excessive losses. The proposed Medicare policies are a good first step that the CLL Society would hope to see fully enacted.

CAR-T is a powerful tool that should be accessible to all who might benefit.

Let’s hope for the best!

Dr. Brian Koffman (retired)
Co- founder, Chief Medical Officer and Executive Vice President, CLL Society