Car-t therapy in the United States

Source: in recent days, medical insurance and Medicaid Service Center (CMS) announced that it agreed to pay hundreds of thousands of dollars to hospitals for car-t therapy to treat specific cancer patients According to a spokesman for the U.S government payment agency, the medical insurance covers the medical needs of specific disabled people, end-stage renal cancer patients or people aged 65 and above through part B of the medical insurance CMS will pay 500000 US dollars to the hospital for car-t therapy kymariah of Novartis and 400000 US dollars to the hospital for car-t therapy yescarta of Gilead However, 20% of patients still need to pay for the treatment Cost In August 2017, FDA approved Novartis car-t therapy kymriah (tisagenlecleucel) to be put on the market for the treatment of B-cell precursor acute lymphoid leukemia (all), and patients under 25 years old who are difficult to treat or have two or more relapses This is the first car-t therapy approved in human history, and also the first gene therapy approved by FDA in the United States! Just two months later, in October 2017, kit Pharma's car-t therapy yescarta (axicabagene ciloleucel) was approved by the FDA and became the second approved car-t therapy for the treatment of relapsed or refractory large B-cell lymphomas patients who have received two or more systems of treatment As the first approved car-t therapy in the world, in addition to the efficacy, kymeriah and yescarta prices have also been concerned At that time, insurance companies and medical and welfare managers (PBMs) predicted that the cost of car-t therapy was very high Sure enough, kymeriah pricing was $475000, yescarta pricing was $373000 In fact, as early as kymeriah was approved, there were patients pricing kymeriah At that time, Novartis responded that the company invested heavily in car-t therapy Considering the short-term and long-term value of the therapy to patients, society and health care system, as well as the opinions of external health economic experts, the payment based on clinical efficacy is also one of the strategies In this way, the payer pays according to the clinical success rate It is also conducive to the American health system to accept new technologies for cancer treatment as soon as possible "Unlike the traditional medical model, this treatment is the first time, and there are many challenges, including the way of payment." Steve Miller, chief medical officer of express scripts Holding Co., one of the largest PBMs in the United States, said that as a result, CMS also carefully assessed the risk of car-t coverage Medicare usually pays for the net price of the drug, as well as the refund to the donor For the treatment covered by Part B of Medicare, the proportion is 6% However, when the drug is a new drug, the health insurance has no information about the net price, so it can only temporarily increase the total wholesale purchase cost by 6% In the management of kymriah and yescarta, CMS sets the outpatient reimbursement rate for them, which also roughly conforms to this dynamic mode As for inpatient care, the cost of car-t is packaged into the whole hospitalization period CMS spokesman confirmed that it has received applications for additional payment for new technologies to allow special payments for drugs or medical services for kymriah and yescarta, and CMS said it would consult the public on these applications in fy2019.