UPDATE: our take on CMS’s latest memo on CAR-T reimbursement

Earlier in the year, we reviewed the reimbursement challenges that CAR-T therapies are experiencing in the US, assessed some of the proposed solutions, and outlined Payers’ expectations from next-generation CAR-T therapies. Click here to see the original analysis.

CMS published a memo providing an update to CAR-T reimbursement in early August that included a number of changes: (1) increased NTAP payments, (2) loosened coverage by dropping the coverage with evidence development (CED) requirement, and (3) reimbursement of off-label use.

While news headlines generally implied that CAR-T therapies will be fully covered and reimbursed, groupH analysis shows that this is far from the case.  We found that the increased NTAP payment is still inadequate, and furthermore, is offset by a reduced outlier payment.

Please click here to download a few slides outlining the key points from the CMS memo, and our take on how this impacts the reimbursement of CAR-T therapies.

Email morris.paterson@groupH.com to arrange an in-person presentation with your team.