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Proposed CMS rule for CAR Ts marks progress in reimbursing new technologies

A new CMS payment rule for CAR Ts could mean better patient access

It’s been four years since the first CAR T cell therapies were approved and inadequate reimbursement is still a barrier to access in the U.S. A new payment rule proposed by CMS aims to change that, and its adoption could provide a road map to faster implementation of payment models for the next new technologies.

On May 11, CMS released its proposed Hospital Inpatient Prospective Payment System rule for 2021, which includes a new Medicare Severity-Diagnosis Related Group (MS-DRG) for CAR T cell therapies.

CMS currently reimburses CAR T inpatient cases at the same rate as bone marrow transplants. The new rule would move them into their own payment category with their own base rate for reimbursement, which would cover the cost of the treatment plus ancillary costs of caring for the patient in the hospital.

That’s an important step for both cell therapy developers and hospitals because CAR Ts carry much higher costs than bone marrow

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