Payers, drugmakers face off over CAR T Medicare coverage
CMS is receiving contradictory recommendations in response to its request for comments about creating a national policy on Medicare payments for CAR T cancer therapies. Payers' and patient advocacy groups' comments urged CMS to institute a National Coverage Determination (NCD) while drugmakers opposed, saying FDA's oversight makes an NCD unnecessary. The public comment period ended on Friday.
America’s Health Insurance Plans (AHIP) cited issues with FDA's inclusion criteria for Kymriah tisagenlecleucel from Novartis AG (NYSE:NVS; SIX:NOVN) as well as overlap between Kymriah and Yescarta axicabtagene ciloleucel treatment groups as areas of concern, while Patients For Affordable Drugs suggested an NCD would help keep CAR T cell pricing affordable for Medicare patients. The Kite Pharma Inc. unit of Gilead Sciences Inc. (NASDAQ:GILD) markets Yescarta...