US: Advocating for adequate reimbursement for hospitals delivering CAR T-cell therapy

Delivering CAR T-cell therapies is a complex process, which may not be reflected in local reimbursement policies. For treatment centers in the US, Medicare reimbursement did not cover the full cost of delivering CAR T-cell therapy under existing payment models. 

The US CAR T Working Group was set up to advocate for policy change to improve patient access to CAR T-cell therapy. It includes over 20 patient advocacy organizations (including Lymphoma Research Foundation), the Association of Cancer Care Centers, the American Society for Transplantation and Cellular Therapy, industry associations (including Alliance for Regenerative Medicine) and biopharmaceutical companies (including Gilead and Kite, Bristol Myers Squibb and Johnson & Johnson).

Through coordinated advocacy, the working group successfully engaged with the Centers for Medicare & Medicaid Services to advocate for the creation of a new Medicare Severity Diagnosis Related Group (MS-DRG) specifically for CAR T-cell therapy. The revised MS-DRG more appropriately compensates hospitals for the costs associated with administering the therapy.¹⁵⁷ 

This change in reimbursement policy has helped increase access to CAR T-cell therapy for Medicare beneficiaries and encourages more hospitals to provide the treatment to eligible patients.