CAR T-Cell Therapy Coverage Decision Improves Medicare Beneficiary Access to Cancer Care

Statement By American Society of Clinical Oncology (ASCO) President Howard A. “Skip” Burris III, MD, FACP, FASCO
August 8, 2019

“ASCO applauds the Centers for Medicare & Medicaid Services (CMS) for releasing a national coverage determination (NCD) on CAR T-cell therapy that provides increased access to an innovative cancer treatment to Medicare beneficiaries nationwide. The determination is largely consistent with ASCO’s principles for CAR T-cell therapy coverage, which support coverage for all Food and Drug Administration (FDA)-approved indications of this treatment.

“We’re also pleased that the NCD removes ambiguity around what CMS will cover with regard to CAR T-cell therapy, such as off-label use listed in CMS-approved compendia. The decision also opens the door for patients to receive CAR T-cell therapy in outpatient settings that are enrolled in FDA risk evaluation and mitigation strategies (REMS) with expertise in delivering cellular therapies, which could potentially expand patient access to the treatment at lower cost.

“ASCO remains concerned, however, that Medicare reimbursement still does not cover the full cost of CAR T-cell therapy. As stated in our principles, we believe that Medicare should cover the full cost of CAR T-cell therapy except for any patient or provider cost-sharing that would apply to any other covered drug or therapy under Medicare.  

“ASCO will continue to work with the Administration to expand patient access to CAR T-cell therapy and to improve cancer care for Medicare beneficiaries.”

ASCO in Action