O’HALLERAN, MARSHALL, DELBENE, AND BUCSHON SECURE MEDICARE PAYMENTS FOR INNOVATIVE CANCER THERAPIES

September 10, 2020
Press Release

WASHINGTON - Representatives Tom O’Halleran (D-AZ), Roger Marshall, M.D. (R-KS), Suzan DelBene (D-WA), and Larry Bucshon, M.D. (R-IN) issued the following statement after the Centers for Medicare & Medicaid Services (CMS) issued a final rule securing access to groundbreaking cancer treatment that the representatives requested.

“CMS’ final rule will now fully cover CAR T-cell therapy, providing lifesaving access to innovative cancer treatments for America’s seniors. New and existing immunotherapies are part of a rapidly advancing field that is delivering hope for patients diagnosed with deadly cancers. In most cases, CAR T-cell recipients have exhausted their other treatment options and receiving this cutting-edge treatment will provide them and their families with renewed hope.”

Earlier this year, the four Representatives urged CMS to establish an appropriate Medicare reimbursement for CAR T-cell therapy. The Representatives had previously met with their local hospitals and patient advocate organizations that underscored how the current reimbursement levels were insufficient to adequately cover the cost of treating these patients and how it was impacting patient access. This rule will provide predictable payment to help broaden seniors’ access to CAR T-cell therapy.

“Across rural Arizona, I hear from families, seniors, and veterans who have to travel many hours to receive the specialized treatment they need, forcing them to seek care away from their homes and support systems,” said O’Halleran. “This rule change will allow hospitals that see a large amount of Medicare patients—like many in rural Arizona—to administer this type of innovative cancer therapy at lower provider cost. As such, patients in more rural areas will have more options and will not have to travel long distances to receive this type of treatment.”

To learn more about CMS’ FY 2021 Medicare Hospital Inpatient Prospective Payment System final rule, click here.

BACKGROUND:

O’Halleran has long advocated for CMS to create a new hospital payment category for CAR T-cell therapy, and sent Administrator Seema Verma a letter in February urging CMS to take up this exact proposed rule change.   

CAR-T is the first-ever gene therapy and uses a patient’s own genetically modified immune cells to treat people with certain types of cancer.

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