The cost of a dose of medicine is generally thought to include just the pills or the fluid in the vial, but CMS has proposed a different way to handle payment for chimeric antigen receptor (CAR) T-cell therapy, one that the medical and manufacturing community thinks is unworkable. Although these agents' prices reach close to 0,000, they still reflect just the reengineered white blood cells, not all the ancillary elements of care, speakers testified at a recent hearing on CMS pricing policy.
CAR T-cell candidates are the “sickest of the sick,” and the amount of time they spend in the hospital could add substantial amounts to the overall cost of care; therefore, those costs of care cannot be handled as a fixed cost, speakers said.
Figure. Multiple Steps in Different Locations are Required for CAR T-cell Preparation
Further, they said, the care of CAR T-cell–eligible patients involves numerous medical entities and providers. According to those who testified, CMS’ wording of Q codes for CAR T-cell therapy resembles an attempt at bundling care that would amount to a compliance nightmare for administrators. “Our system is not set up to separate those kinds of things,” said Aaron D. Chrisman, MHA, MBA, director of stem cell transplant and cellular therapy administration at University of Chicago Medicine in Illinois.
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