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Medicare to Cover Costly New Treatment for Some Cancers

Innovative therapy used for advanced lymphoma gets nationwide coverage

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Medicare will begin nationwide coverage of CAR T-cell therapy, a complicated treatment for some cancer patients who have run out of other treatment options, the Centers for Medicare and Medicaid Services (CMS) announced on Wednesday.

The Food and Drug Administration has approved chimeric antigen receptor T-cell, or CAR T-cell, therapy to treat some specific cancers, including certain types of non-Hodgkin’s lymphoma. The treatment involves removing some of the patient’s own CAR T-cells, genetically modifying them, and then putting them back into the patient so they can attack a protein on the surface of cancer cells. The treatment — which is applied once — is estimated to cost between $375,000 and $475,000.

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“Today’s coverage decision provides consistent and predictable patient access nationwide,” CMS Administrator Seema Verma said in a statement. “CMS will work closely with our sister agencies to monitor outcomes for Medicare patients receiving this innovative therapy going forward.”

Medicare said it will cover CAR T-cell therapy when it is performed in facilities enrolled in an FDA safety program that includes training in handling side effects of such treatments.

“We’ve recently seen dramatic progress in the development of CAR T-cell therapies and other treatments that harness patients’ own immune cells to treat their cancers, and we continue to learn more in clinical studies,” says Douglas R. Lowy, acting director of the National Cancer Institute, where the first successful cancer treatment with CAR T-cells was developed. “By partnering with CMS and FDA, we have an opportunity to increase our understanding of how different patients’ cancers respond to these treatments through the collection of this data, ultimately allowing us to better understand who will benefit from these therapies.”

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