Arizona lawmakers urge Centers for Medicare and Medicaid Services to act on cell therapy classification

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Ohalleran
U.S. Rep. Tom O'Halleran

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Arizona’s U.S. House members Tom O’Halleran (D), Ann Kirkpatrick (D), and David Schweikert (R) were among the bipartisan group of more than 70 members of the U.S. House of Representatives to urge the Centers for Medicare and Medicaid Services (CMS) to create a unique payment code for chimeric antigen receptor T-Cell (CAR T-cell) immune therapy for cancer patients.

Providing a unique payment code for CAR T-cell immune therapy would make it easier for individuals across the country to get this one-time treatment, which is used to fight certain blood cancers.  Available therapies using CAR T-cell cost up to $1.5 million for an entire course of treatment (including hospital costs). The infusion of cells costs an estimated $400,000.

O’Halleran did not respond to multiple requests for comment for this story. But he signed on to the letter, which was obtained by Politico. The letter communicates to CMS that failure to create a permanent payment mechanism for the treatment could seriously hinder patient access, especially in rural areas where Medicare beneficiaries face difficulties in finding a hospital that can administer the treatment.   

In the letter to Administrator Seema Verma, legislators praise the national coverage determination as a “monumental first step in providing access to these revolutionary medicines to Medicare patients.”

Representatives are urging urge CMS to act before the current payment model expires Sept. 30. At that point, the CAR T-cell therapy would shift to a bundled payment based on the patient’s condition, and reimbursed at the level of its Medicare Severity-Diagnosis Related Group (MS-DRG).   

Legislators are not alone in advocating the treatment to get its own DRG. Drug companies, patient and provider groups have also asked for this change.

Arizona legislators who signed on to the letter included O’Halleran Kirkpatrick and Schweikert.

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