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CAR-T Therapy Gets Final CMS Approval For Medicare Coverage

CAR-T therapy is a treatment in which a patient’s T immune cells cells are genetically changed in the laboratory so they can bind to cancer cells and kill them. It has thus far proven to be a successful way to fight and reduce cancer. In addition, it has been approved by the FDA.


Blood from a cancer patient’s arm is filtered to remove the white blood cells together with the T cells.  Next, the gene for a special receptor called a chimeric antigen receptor (CAR) is inserted into the T cells in the laboratory. Millions of the CAR T cells are grown in the laboratory and then infused back into the cancer patient. The CAR T cells then find and bind to the cancer cells and kill them. Essentially, the cancer patient’s own immune system is strengthened to fight the disease.


Right now, Car-T therapy is given to leukemia, myeloma and lymphoma cancer patients. These cancers are various forms of blood disease. To date, this therapy has been very successful — close to 80 percent of treated patients show either tumor reductions or total remission.



car-t therapy



Car-t Therapy: Works Great But Very Expensive

While the Car-T treatment thus far is successful — the cost is incredibly high. One treatment session can cost approximately 1.5 million dollars! And even so, there are hospitals that charge between 2 and 2.5 million dollars per session, just so they break even.


Medicare will now pay as long as treatments are administered in health care facilities that follow  FDA safety rules.  Medicare will also pay even when it’s used to treat conditions that aren’t FDA-approved.  Tight now, there are two trademark treatments on the market —  Gilead’s Yescarta and Novartis’ Kymriah. They are FDA approved to treat non-Hodgkin lymphoma and acute lymphoblastic leukemia.


The new policy is a positive development for hospitals. They complained that lack of coverage limited their ability to provide treatments.


The new Medicare coverage now provides consistent and predictable patient coverage across the entire United States.

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