Many questions to ask in setting national coverage for CAR-T Therapies

Next week, a CMS committee will hold a daylong meeting to discuss a national coverage determination (NCD) for chimeric antigen receptor (CAR) T-cell immunotherapies, the game-changing cancer treatment approved by the FDA for 2 indications, and being studied for more.

The request for an NCD was put forth by UnitedHealthcare, the nation’s largest insurer and also the largest provider of Medicare Advantage plans. With a 1-time treatment costing $400,000 and unpredictable related hospital stays and treatment for complications, payers are watching this issue with intense interest, especially if the patient pool expands.

In New England Journal of Medicine, Peter B. Bach, MD, MAPP, reviewed several strategies open to CMS as it continues to try to determine how to pay for CAR T, the costliest cancer treatment invented to date.1

Tisagenlecleucel (Kymriah)—a treatment for children and young adults with B-cell acute lymphoblastic leukemia developed by Novartis—is priced at about $475,000 for a 1-time treatment. Axicabtagene ciloleucel (Yescarta)—Kite Pharma/Gilead’s treatment for adult patients with relapsed or refractory large B-cell lymphoma—is priced at $373,000.

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