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Medicare sets outpatient CAR T-cell therapy rates


On the inpatient side, Medicare payment for CAR T-cell therapy is currently bundled into the payment for the inpatient stay, rather than being paid separately. The drug manufacturers – Gilead Sciences and Novartis AG – have requested that CMS set a separate “new technology add-on payment,” but the agency has not yet issued a decision.

Courtesy Dr. Richard Maziarz
Dr. Richard Maziarz
The CMS announcement is the latest development in the rapidly growing landscape of CAR T-cell therapies. The treatments center on drawing T cells from patients, modifying them to attack cancer, and infusing them back into patients. Last year, the Food and Drug Administration approved Novartis’s tisagenlecleucel for pediatric acute lymphoblastic leukemia and Kite Pharma’s axicabtagene ciloleucel for relapsed/refractory large B-cell lymphoma in adults. Gilead Sciences has since acquired Kite Pharma.

Further advancements are expected for CAR T-cell therapies in 2018, said Cai Xuan, PhD, senior analyst in oncology and hematology for GlobalData, a data analytics and commercial intelligence firm.

For starters, pharmaceutical companies are now working toward next-generation CAR T-cell therapies that can be mass produced, Ms. Xuan noted. At a recent American Association for Cancer Research meeting, for example, the biopharmaceutical company Cellectis presented early clinical data in pediatric B-cell acute lymphoblastic leukemia for its off-the-shelf CAR T-cell candidate UCART19. Additionally, CRISPR Therapeutics presented preclinical data for one of its off-the-shelf CAR T-cell candidates for multiple myeloma, and the company announced it would apply for approval to start human trials by the end of 2018.