On August 30, ASBMT had the privilege of meeting with Seema Verma, Administrator for the Centers of Medicare and Medicaid Services (CMS). She met with several ASBMT leaders—including President John DiPersio, Executive Director Andre Williams, and Director of Health Policy & Strategic Relations Stephanie Farnia—to discuss Medicare inpatient final rule for CAR-T therapies.
In late August, the CMS put forward a new payment scheme that categorizes CAR-T therapies under Medicare Severity-Diagnosis Related Groups. With the new rule, the use of these therapies will have a maximum threshold of $186,500 per case, starting in 2019.
While many regard this as an improvement to the payment structure, it still is far off from covering the cost of the products or full hospitalization costs. Farnia and others on ASBMT’s Government Affairs team coordinated a meeting with Verma to address their concerns about the cost.
“We were hoping the Medicate Inpatient Final Rule for CAR-T would cover 100 percent for the cost of the drug,” Williams said. “The final rule places a financial hardship on health systems to cover the remaining cost for the drug.”
During the meeting with Verma, ASBMT was able to present their case on why these costs should be covered. Williams said he believes it opened the door for ASBMT to work further with CMS on the issue.
“Seema Verma listened to our concerns and showed genuine interest in working with ASBMT to find a solution to reimbursement issue,” Williams said.
He said everyone was honored to meet with Verma, who was appointed to the office in March 2017.
