A Word from President Krishna Komanduri, MD
Dear Colleagues,
As I write this, I am honestly amazed at how 2017 has flown by. This column will mark my last of the calendar year, and as you read this those of you who will not be providing vital clinical care over the holidays will likely be thinking ahead to some well-deserved time with your loved ones over the winter break. Like me, you’ll also be contemplating resolutions for the new year that we hope will persist at least into springtime.
When I last wrote, the ASBMT was about to conduct two events that highlight to me the vitality and critical efforts of the Society. The first was the biennial Cell Therapy Training Course conducted in collaboration with the ISCT and the second was our Annual Fall Clinical Education Conference. These events were held during the same October week in Seattle, thanks to efforts of our colleagues at the Hutch. Both the training course and the education meeting were spectacular successes. I was privileged to participate in both meetings and remain extraordinarily grateful for the efforts of the dedicated chairs, and for the time and energy invested by the many ASBMT members who presented to the receptive audiences in both venues. Already, plans are underway to consider how to continue our success with the ASBMT/ISCT 2019 Cell Therapy Training Course and the 2018 Fall Education Conference.
I noted last month the approval of a second transformative CAR-T therapy (Yescarta for CD19+ lymphomas failing prior therapies) and continued to highlight the many ASBMT efforts to ensure patient access and sustainable success of cellular immunotherapies, including autologous engineered T cell therapy. The ASBMT continues to be a leader in advancing the regulatory and reporting framework that will be needed to track clinical activity and obtain reimbursement for these therapies. For example, the Society is leading efforts to develop codes (e.g., CPT codes to designate efforts to prepare and infuse engineered T cell products) needed to ensure tracking and reimbursement of efforts. Since prices could not be anticipated prior to FDA approvals, and since reimbursement frameworks for public and private payers follow approval, we are closely monitoring issues of access and reimbursement critical to the cell therapy centers and patients who are at the core of our membership and mission.
One issue of immediate concern is the lack of a suitable Medicare reimbursement model for inpatient care of older patients, who are expected to constitute a significant fraction of patients eligible to receive and likely to benefit from CD19-directed CAR-T therapies for lymphoma. Medicare reimbursement models struggle to adjust to new technologies used in the inpatient (MS-DRG) ) setting and adjustment to reimbursement rates can lag years behind introduction of new technologies. Due to the unique aspects of CAR-T, in that it is a new therapy with high cost but potentially significant benefit, we are concerned that the delay in the usual Medicare reimbursement adjustment processes will create financial barriers to care in the short-term. Our advocacy in this arena has included direct comments to the Centers for Medicare and Medicaid Services (CMS) to ensure adequate reimbursement that will be needed to provide access to patients at great need for these therapies. In November, I along with Stephanie Farnia, our health policy director, and others met with senior officials in the Center for Medicare and Medicaid Innovation (CMMI) to discuss these concerns. Critically, it is not our role to directly comment on or defend pricing of these products, but to ensure that the provision of these therapies in the transplant and cell therapy centers we represent is both viable and sustainable from a clinical and financial perspective, irrespective of care setting. We will continue to address all aspects of these developing therapies, including advancing the science, clinical care and health economics framework needed to ensure there short and long-term success.
As the year ends, I want to remind all of you to vote in the ASBMT elections for new officers (including our 2020-2021 President!) and to finalize your plans to attend the 2018 Tandem Meetings in Salt Lake City. I’m excited to report that at this early stage that advance registrations are running ahead of the record pace of the last two meetings, which reflects the vitality of our field and the outstanding program that Jerry Ritz and Fred Appelbaum (ASBMT and CIBMTR meeting co-chairs) have put together. I look forward to the incredible scientific and clinical exchange that will occur in February.
Finally, I want to thank all of you for your support, feedback and efforts on behalf of the Society in 2017. I wish each of you a very happy and restful holiday season, and hope that the new year is filled with personal and professional success, good health and joy for you and your loved ones. I will give thanks over this holiday for the great privilege of leading this Society, and to seeing and interacting directly with many of you in 2018.
Krishna
Back to the December 2017 issue of eNews.