Tag: Chimeric antigen receptor

Cancer patients, doctors and drug companies are urging the Trump administration to remove the restrictions and broaden coverage so more patients can benefit from the treatment, known as CAR T cell therapy, or CAR-T. Medicare and other insurers typically pay for drugs as they are used, from month to month and year to year. The Trump administration has proposed covering CAR-T therapy when it is prescribed by a cancer specialist and given in a hospital to Medicare patients whose cancer has not responded to other treatments like chemotherapy and radiation. “But when you actually consider what you are paying for over the course of someone’s lifetime, and you think about the cost of other therapies that this is replacing, it actually is not astronomical.” There is no national Medicare policy for covering CAR T cell therapy. The request for a Medicare coverage decision came from one of the nation’s largest insurers, UnitedHealth Group, which expressed concern that “CAR-T therapies could create significant financial risks” for the government and for private Medicare Advantage plans. UnitedHealth is the largest provider of Medicare Advantage plans, with about five million people enrolled in its plans. Approving payment for this therapy right now will save the lives of patients who have run out of other options.” Advocates for patients and physician groups said the coverage policy proposed by the Trump administration was too limited and could delay lifesaving treatment for cancer patients who were very ill. “We have a new therapy, a result of years of research, and it has been approved by the F.D.A.,” said Kirsten A. Sloan, a vice president of the American Cancer Society Cancer Action Network. A patient’s health care provider is in the best position to determine when and whether a patient will benefit from CAR T cell therapy and should not be limited by a narrow coverage policy.” Ted Okon, the executive director of the Community Oncology Alliance, an advocacy group for cancer doctors and patients, said the coverage criteria proposed by the Trump administration were “much more restrictive” than the uses of CAR-T therapy permitted in the F.D.A.-approved label. “No one anticipated such an extraordinary expense when Medicare’s hospital payment formulas were adopted.” Under the Trump administration proposal, Medicare would pay for CAR-T therapy in patients who have “relapsed or refractory cancer” that has resisted other treatments. The eligibility requirements “may exclude some patients who could benefit from treatment,” said Cynthia A. Bens, a senior vice president of the Personalized Medicine Coalition, an education and advocacy group.