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Medicare Payment Relief For CAR-T Limited To Higher Add-On Payments In 2020

 
• By Cathy Kelly

US Centers for Medicare and Medicaid Services concludes structural changes to existing payment systems to accommodate the high cost of Novartis’ Kymriah and Gilead’s Yescarta are still “premature.”

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Medicare Add-On Payments For CAR-T Will Total $94m

Medicare payments to hospitals treating cancer patients with Novartis AG’ Kymriah (tisagenlecleucel) and Gilead Sciences Inc.’s Yescarta (axicabtagene ciloleucel) will not increase significantly in 2020 despite requests from manufacturers, providers and other advocates, which argue that access to the treatment is currently challenged by inadequate reimbursement.

In its 2020 Medicare payment update final rule for hospital inpatient services and technologies, released 2 July, the Centers for Medicare and Medicaid Services confirmed it will continue new technology add-on payments (NTAPs) for the chimeric antigen receptor therapies and increase the NTAP amount for CAR-T and other qualifying new technologies from 50% of costs to 65%

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