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Medicare Add-On Payments For CAR-T Should Reflect 80% Of Actual Costs, CMS Told

 
• By Cathy Kelly

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.

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Some Hospitals Boost CAR-T Billed Charges So They Qualify For Full NTAPs

Medicare should change its method for calculating new technology add-on payments for CAR-T treatments in addition to increasing the payment amount, manufacturers and providers urge in recent comments to the Centers for Medicare and Medicaid Services.

In a recent proposed rule setting Medicare's inpatient hospital payments and policies for 2020, CMS proposed boosting NTAPs from representing 50% of hospital costs to 65% to close the considerable gap between the cost of chimeric antigen receptor T-cell (CAR-T) treatment and what Medicare currently pays

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