Medicare CAR-T Payment Policy Walks Line Between Innovation and Cost Concerns

CMS proposes new DRG with higher average payment rate for CAR-T therapy but signals new technology add-on payments will no longer be awarded to supplement reimbursement. 

Slacklining is a practice in balance that typically uses nylon or polyester webbing tensioned between two anchor points. Tight rope walk
CMS Balances Competing Interests In Medicare IPPS

The Centers for Medicare and Medicaid Services balances support for innovation with controlling costs in its latest policy on Medicare reimbursement for chimeric antigen receptor T-cell (CAR-T) therapies.

More from Pricing Debate

Think Tank Suggests CMS, USTR Could Enforce Most Favored Nation, Other Drug Pricing Policies

 
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A Republican think tank suggested variations of the Most Favored Nation and international reference policies in Medicare and Medicaid, as well as tariffs and other trade levers to rebalance drug pricing disparities between US countries and abroad.

CMS Nominee Oz Nears Confirmation Despite Concerns About Medicaid Cuts

 
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Democrats opposed the nomination because they believe Mehmet Oz will not defend Medicaid from spending cuts. His pledge to continue lowering drug costs in Medicare and Medicaid did not offset the concerns.

Branded Pharma And Generics Industries At Odds Over UK VPAG Framework

 

The UK branded drug industry is calling for adjustments to be made to the UK voluntary scheme framework for branded medicines, after the payment rate increased to 22.9% for 2025. Meanwhile, the generics industry says the scheme is functioning “as intended” and opposes any changes.

‘Hope And Scientific Spillover’ – Cross-Atlantic HTA Alliance To Focus On Novel Benefits

 

An initiative run by health technology appraisal (HTA) bodies in the US, Canada and England is looking at how non-traditional treatment benefits, such as the value of hope and scientific spillover, can inform appraisals and understanding of a product’s value.

More from Market Access

Dramatic HHS Layoffs A Response To ‘Existential Crisis,’ Kennedy Advisor Argues

 
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Calley Means defended reductions in force at the Health and Human Services Department that shocked and outraged federal workers and stakeholders.

Brazilian Drug Price Increase Rates Hit Eight-Year Low

 

CMED, which sets medicine prices in Brazil, has published the maximum price adjustment index for 2025.

England’s NICE Wants Industry Involvement In HTA Sandbox Projects

 

Pharmaceutical companies are being encouraged to reach out to NICE in relation to its HTA Innovation Lab, which provides a sandbox environment in which the health technology assessment body can test new methods of evaluating “innovative and disruptive” therapies.