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CMS Announces Medicare Will Cover CAR T Cancer Treatment

The Centers for Medicare & Medicaid Services (CMS) announced that Chimeric Antigen Receptor T-Cell (CAR T) therapy will be covered for Medicare beneficiaries nationwide. This marks CMS’ first national coverage decision on the innovative cancer treatment.

CAR T therapy uses a patient’s own genetically modified immune cells to fight disease. It is approved by the Food and Drug Administration for use with certain types of non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia.

CMS acknowledged that challenges remain in hospital reimbursement for the therapy, which costs up to $475,000. Under the recently finalized fiscal year 2020 Inpatient Prospective Payment System, CMS will reimburse hospitals at least 65 percent of the treatment’s cost.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Rachel Schwartz is a policy associate at America's Essential Hospitals.

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