Dr. Goy on Need for Payment Model for CAR T-Cell Therapy

Andre Goy, MD, MS
Published: Friday, Nov 16, 2018



Andre Goy, MD, MS, chairman and executive director of the John Theurer Cancer Center at Hackensack University Medical Center, discusses the affordability of cancer treatment breakthroughs such as chimeric antigen receptor (CAR) T-cell therapy.

Although CAR T-cell therapy is a game changer in the treatment of acute lymphoblastic leukemia (ALL), large B cell lymphoma, and non-Hodgkin lymphoma, some challenges remain: its prohibitive cost and lack of established payment pathways. FDA-approved CAR T-cell therapies cost $375,000 for ALL and $475,000 for B-cell lymphoma. The first CAR T-cell therapy, tisagenlecleucel (Kymriah), was approved in August 2017 for select patients with non-Hodgkin lymphoma. Medicare, however, is slowly moving toward providing a code to cover at least part of these treatments. A payment model from payers is also anticipated.

Goy argues that when second-generation CAR T-cell therapy is developed that has better efficacy, less toxicity, and therefore fewer hospital costs because patients can be treated at home, payers should view the treatment as a value-added proposal and facilitate payment.
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Andre Goy, MD, MS, chairman and executive director of the John Theurer Cancer Center at Hackensack University Medical Center, discusses the affordability of cancer treatment breakthroughs such as chimeric antigen receptor (CAR) T-cell therapy.

Although CAR T-cell therapy is a game changer in the treatment of acute lymphoblastic leukemia (ALL), large B cell lymphoma, and non-Hodgkin lymphoma, some challenges remain: its prohibitive cost and lack of established payment pathways. FDA-approved CAR T-cell therapies cost $375,000 for ALL and $475,000 for B-cell lymphoma. The first CAR T-cell therapy, tisagenlecleucel (Kymriah), was approved in August 2017 for select patients with non-Hodgkin lymphoma. Medicare, however, is slowly moving toward providing a code to cover at least part of these treatments. A payment model from payers is also anticipated.

Goy argues that when second-generation CAR T-cell therapy is developed that has better efficacy, less toxicity, and therefore fewer hospital costs because patients can be treated at home, payers should view the treatment as a value-added proposal and facilitate payment.



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