Trend Watch

CMS increases CAR T reimbursement by 15%

Seema Verma, MPH
Seema Verma

CMS has finalized its plan to increase its new technology add-on payment to 65% of the total cost of chimeric antigen receptor T-cell therapies.

The payment increase will take affect with fiscal year 2020 and is a 15% increase over the current 50% new technology add-on payment (NTAP) CMS pays hospitals for the treatments.

CMS proposed the payment increase in April of this year. CAR T-cell therapy was one of 18 new technologies for which CMS approved the higher NTAP payment.

It has been a decade since CMS has changed its NTAP payment policy, according to its administrator, Seema Verma, MPH.

“With changes to our new technology add-on payment (NTAP) policy, we’re #FosteringInnovation and giving more clarity to innovators so beneficiaries have access to the latest technology,” Verma wrote via Twitter.

The 15% increase has received mixed reviews according to experts in the field. Their consensus is that although any increase is welcomed to promote greater access to these treatments, the increase does little to help cover the overall costs of administering them.

The FDA has approved two CAR T-cell therapies: axicabtagene ciloleucel (Yescarta; Kite/Gilead) for adults with relapsed or refractory large B-cell lymphoma and tisagenlecleucel (Kymriah; Novartis) for adults with relapsed or refractory large B-cell lymphoma and pediatric patients with relapsed or refractory acute lymphoblastic leukemia.

Axicabtagene ciloleucel costs $373,000, whereas tisagenlecleucel costs $475,000 – both for a single treatment. The total cost of administering both treatments has been estimated to more than double the drug price tag cost, considering required post-treatment inpatient hospitalization and treatment for toxic side effects.

Wui-Jin Koh

Wui-Jin Koh, MD, chief medical officer of the National Comprehensive Cancer Network had a cautiously optimistic reaction to CMS’ decision to increase the NTAP.

“NCCN is glad to see that CMS recognizes the need to ensure beneficiary access to innovative and evidence-based therapies, in part through increasing the NTAP from 50% to 65% for CAR T-cell therapy,” Koh told HemOnc Today.

“However, we are concerned it does not go far enough, as it still leaves providers with a potential six-figure deficit for each patient receiving CAR T therapy. A reimbursement gap of that size is unsustainable and will lead to patient access issues. Additionally, we continue to be concerned that CMS has not addressed the need for adequate CAR T reimbursement within the exempt cancer hospital system.”

The American Society of Hematology, which previously wrote the CMS asking it to consider a higher NTAP, said it is still reviewing the CMS final ruling before it will give a detailed statement on the issue.

However, policy staff at ASH told HemOnc Today that the decision “is a step in the right direction but does not go far enough to help institutions providing this potentially lifesaving therapy.”

Both ASH and the NCCN had previously sent letters to the CMS asking it to consider raising the NTAP to 80% of the product’s total cost. – by Drew Amorosi

References:

American Society of Hematology. ASBMT and ASH submit letter on CMS Medicare inpatient final rule. Available at: http://www.hematology.org/Advocacy/ASH-Testimony/2018/9101.aspx. Accessed August 5, 2019.

CMS. Trump administration finalizes policies to advance rural health and medical innovation. Available at: www.cms.gov/newsroom/press-releases/trump-administration-finalizes-policies-advance-rural-health-and-medical-innovation?utm_source=TWITTER&utm_medium=social&utm_content=20190802_2526994236&utm_campaign=Medicare&linkId=71473989. Accessed August 5, 2019.

National Comprehensive Cancer Network. NCCN submits letter on CMS 2020 IPPS proposed rule. Available at: www.nccn.org/professionals/meetings/oncology_policy_program/pdf/2019_NCCN_2020_IPPS_Comment_Letter.pdf. Accessed August 5, 2019.

Disclosures: Koh reports no relevant financial disclosures.

Seema Verma, MPH
Seema Verma

CMS has finalized its plan to increase its new technology add-on payment to 65% of the total cost of chimeric antigen receptor T-cell therapies.

The payment increase will take affect with fiscal year 2020 and is a 15% increase over the current 50% new technology add-on payment (NTAP) CMS pays hospitals for the treatments.

CMS proposed the payment increase in April of this year. CAR T-cell therapy was one of 18 new technologies for which CMS approved the higher NTAP payment.

It has been a decade since CMS has changed its NTAP payment policy, according to its administrator, Seema Verma, MPH.

“With changes to our new technology add-on payment (NTAP) policy, we’re #FosteringInnovation and giving more clarity to innovators so beneficiaries have access to the latest technology,” Verma wrote via Twitter.

The 15% increase has received mixed reviews according to experts in the field. Their consensus is that although any increase is welcomed to promote greater access to these treatments, the increase does little to help cover the overall costs of administering them.

The FDA has approved two CAR T-cell therapies: axicabtagene ciloleucel (Yescarta; Kite/Gilead) for adults with relapsed or refractory large B-cell lymphoma and tisagenlecleucel (Kymriah; Novartis) for adults with relapsed or refractory large B-cell lymphoma and pediatric patients with relapsed or refractory acute lymphoblastic leukemia.

Axicabtagene ciloleucel costs $373,000, whereas tisagenlecleucel costs $475,000 – both for a single treatment. The total cost of administering both treatments has been estimated to more than double the drug price tag cost, considering required post-treatment inpatient hospitalization and treatment for toxic side effects.

Wui-Jin Koh

Wui-Jin Koh, MD, chief medical officer of the National Comprehensive Cancer Network had a cautiously optimistic reaction to CMS’ decision to increase the NTAP.

“NCCN is glad to see that CMS recognizes the need to ensure beneficiary access to innovative and evidence-based therapies, in part through increasing the NTAP from 50% to 65% for CAR T-cell therapy,” Koh told HemOnc Today.

“However, we are concerned it does not go far enough, as it still leaves providers with a potential six-figure deficit for each patient receiving CAR T therapy. A reimbursement gap of that size is unsustainable and will lead to patient access issues. Additionally, we continue to be concerned that CMS has not addressed the need for adequate CAR T reimbursement within the exempt cancer hospital system.”

PAGE BREAK

The American Society of Hematology, which previously wrote the CMS asking it to consider a higher NTAP, said it is still reviewing the CMS final ruling before it will give a detailed statement on the issue.

However, policy staff at ASH told HemOnc Today that the decision “is a step in the right direction but does not go far enough to help institutions providing this potentially lifesaving therapy.”

Both ASH and the NCCN had previously sent letters to the CMS asking it to consider raising the NTAP to 80% of the product’s total cost. – by Drew Amorosi

References:

American Society of Hematology. ASBMT and ASH submit letter on CMS Medicare inpatient final rule. Available at: http://www.hematology.org/Advocacy/ASH-Testimony/2018/9101.aspx. Accessed August 5, 2019.

CMS. Trump administration finalizes policies to advance rural health and medical innovation. Available at: www.cms.gov/newsroom/press-releases/trump-administration-finalizes-policies-advance-rural-health-and-medical-innovation?utm_source=TWITTER&utm_medium=social&utm_content=20190802_2526994236&utm_campaign=Medicare&linkId=71473989. Accessed August 5, 2019.

National Comprehensive Cancer Network. NCCN submits letter on CMS 2020 IPPS proposed rule. Available at: www.nccn.org/professionals/meetings/oncology_policy_program/pdf/2019_NCCN_2020_IPPS_Comment_Letter.pdf. Accessed August 5, 2019.

Disclosures: Koh reports no relevant financial disclosures.

    See more from Immuno-Oncology Resource Center