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CMS unveils CAR-T proposal, with emphasis on patient outcomes

“Two CAR-T therapies — Novartis’ Kymriah (tisagenlecleucel) and Gilead Sciences’ Yescarta (axicabtagene ciloleucel) — are already on the market, yet their high price tags and potentially one-time administration has put pressure on CMS to figure out a way to cover these kinds of treatments.

The agency took a few steps toward that goal over the last year. In April, it agreed to reimburse hospitals about $400,000 for Yescarta and $500,000 for Kymriah through Medicare Part B, which covers outpatient medical needs for people who have certain disabilities, end-stage renal cancer or are at least 65 years old. A month later, CMS said it would conduct National Coverage Analysis for CAR-T therapies to be completed by May 17, 2019.

Still, some worry not enough is being done to tackle the reimbursement challenges these complex treatments present.”

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