November 08, 2020
Feedback from facilities in the United States currently providing inpatient chimeric antigen receptor T‐cell (CAR‐T) therapy about the financial viability of the treatment warrant concern, warns a survey-based study published in published in The Oncologist.
“Reimbursement has been slow, and in some cases, the amount is well below the cost of delivering CAR‐T therapy,” researchers wrote. “For example, total inpatient reimbursement for CAR‐T therapy set by the Centers for Medicare & Medicaid Services was initially only $186,500 for adult patients with lymphoma, far below the costs of the CAR‐T product itself ($373,000). Even with recent increases in inpatient reimbursement to $242,450 per case, reimbursement remains well below costs.”
To gauge providers’ perceptions of the financial viability of inpatient CAR-T therapy, researchers reached out to 92 CAR-T certified centers in the United States with a survey. Some 22% responded, and more than three quarters of them reported their facilities treat patients in inpatient settings. Sixty percent indicated the majority of patients had commercial insurance.
On a scale from 1 to 100, the median rating of the financial viability of their institution’s CAR-T therapy program across centers was 62, according to the study. Nearly three quarters of respondents who rated financial viability below 100 said reimbursement needed to change, while 33% said the high cost of the product needed to change. Almost a third of respondents acknowledged using institutional markups in an attempt to maximize reimbursement.
“Access to costly therapies like CAR‐T often faults the most vulnerable populations,” researchers concluded. “Although centers are quickly finding ways to redeem financial losses, payers, manufacturers, and health systems have an obligation to work together on more sustainable financing arrangements to enable patients to realize the full benefits of these promising new therapies.”
Leech AA, Neumann PJ, Cohen JT, Jagasia M, Dusetzina SB. Balancing Value with Affordability: Cell Immunotherapy for Cancer Treatment in the U.S. Oncologist. 2020;25(7):e1117-e1119. doi:10.1634/theoncologist.2020-0025