California Representatives urge CMS to create a new payment code for CAR-T cell treatment

Cancer patients in California who have Medicare health care coverage should have a specific payment code for the Chimeric Antigen Receptor T-cell (CAR T-cell) immunotherapy treatment, say California legislators who joined in a Feb. 12 letter to Seema Verma, administrator of the Centers of Medicare and Medicaid Services.

Seventy-six members of the U.S. House of Representatives from both parties came together to author a letter urging CMS to create a permanent payment code for the CAR-T cell treatment to simplify how it is billed and to do it before the current model expires on Sept. 30. 

Reimbursement for the treatment is an issue because there’s a gap that could leave healthcare providers with large deficits and will likely cause access issues for patients, especially those in rural areas.  

This immunology treatment for cancer is a one-time infusion of engineered cells to fight certain cancers, and it’s expensive. These therapies can cost $400,000, and when you add in hospital costs and the full course of treatment, that cost can balloon to $1.5 million.

In the letter, legislators wrote that “rural patients already face potential access challenges due to their lack of immediate proximity to authorized treatment centers and highlights the importance of maintaining access to those facilities located within reasonable proximity that can provide this therapy to neighboring rural areas.”  They note that for hospitals that treat large numbers of Medicare patients, the reimbursement gap will be particularly problematic.

California legislators who signed on to the letter include Rep. Mike Thompson (D-CA-05); Rep. Jimmy Panetta (D-CA-20); Rep. Devin Nunes (R-CA-22); Rep. Ted Lieu (D-CA-33);  and Rep. Linda T. Sanchez (D-CA-38).

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