The U.S. Centers for Medicare and Medicaid Services will slightly increase coverage for expensive CAR-T cell therapies.

CMS, which runs the federal government’s healthcare plan for seniors, issued a proposed rule raising its maximum “new technology add-on payment” (NTAP) from 50% of estimated costs to 65%, which would increase reimbursement to $242,450 from the current $186,500.

While this is good news for patients, it does not cover the full cost of the currently approved therapies Yescarta (Gilead) and Kymriah (Novartis) which are priced between $373,000 and $475,000.

CAR-T cell therapies are not yet approved for use in multiple myeloma patients. There are a number in development including bb21217 and MCARH171 in Phase I clinical development, JCARH125 and LCAR-B38M are being evaluated in ongoing Phase I/II clinical trials, and bb2121 is at the most advanced development stage, with a pivotal Phase II study underway. 2-6

References:

  1. Beasley D. (2019, April 22). Medicare offers to partially raise payment for cancer CAR-Ts. Retrieved from: https://www.reuters.com/article/us-health-medicare-cancer/medicare-offers-to-partially-raise-payment-for-cancer-car-ts-idUSKCN1RZ2JC
  2. 2. ClinicalTrials.gov. Study of bb21217 in Multiple Myeloma. https://clinicaltrials.gov/ct2/show/NCT03274219. Accessed 18 April, 2019.
  3. ClinicalTrials.gov. Study Evaluating the Safety and Efficacy of JCARH125 in Subjects With Relapsed and/or Refractory Multiple Myeloma (EVOLVE). https://clinicaltrials.gov/ct2/show/NCT03430011. Accessed 18 April, 2019.
  4.  ClinicalTrials.gov. BCMA Targeted CAR T Cells With or Without Lenalidomide for the Treatment of Multiple Myeloma. https://clinicaltrials.gov/ct2/show/NCT03070327. Accessed 18 April, 2019.
  5. ClinicalTrials.gov. Efficacy and Safety Study of bb2121 in Subjects With Relapsed and Refractory Multiple Myeloma (KarMMa) (bb2121). https://clinicaltrials.gov/ct2/show/NCT03361748. Accessed April 18, 2019.
  6. ClinicalTrials.gov. LCAR-B38M-02 Cells in Treating Relapsed/Refractory (R/R) Multiple Myeloma (LEGEND-2). https://clinicaltrials.gov/ct2/show/NCT03090659. Accessed 18 April, 2019.
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