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REIMBURSEMENT UPDATE

Advocacy Update: NMDP/Be The Match Hosts a Capitol Hill Briefing 

On March 21st in Washington, D.C., the National Marrow Donor Program® (NMDP)/Be The Match® held an awareness briefing celebrating the successful transplant pairing and first-time meeting of donor, Kyndess Eaggleston and recipient, Kate Jauch.

Read more about Kyndess and Kate's journey >


Economic Report: ICER CAR T-Cell Effectiveness and Value

On March 23, the Institute for Clinical and Economic Review (ICER) released its Final Evidence Report of Effectiveness and Value for Chimeric Antigen Receptor (CAR) T-Cell Therapy for B-Cell Cancers, including childhood B-cell acute lymphoblastic leukemia (B-ALL) and aggressive B-cell non-Hodgkin lymphoma (NHL) in adults. ICER sought to investigate whether the new CAR T-cell therapies provided a net clinical benefit and long-term cost-effectiveness when compared to standard chemoimmunotherapy regimens for specified indications. A key finding on access to CAR T-cell therapies is that, at current cost ($373,000 per patient) and during any given year, our health care system can only afford to treat about one-third of patients eligible to receive axicabtagene ciloleucel (Yescarta) for relapsed/refractory NHL; this percentage could reach one hundred if the cost of the drug were discounted to approximately $220,000 per patient. As a result, a policy recommendation from the policy roundtable discussion was to implement innovative payment models such as value-based pricing with the context of affordability, outcomes-based pricing arrangements, consideration of public contributions to cost of research and development, removal of barriers to indication-specific pricing, and hospital mark-up practices that reflect cost-of-care rather than percentage of drug cost.

Read a summary of ICER's report.
Read ICER's full report.

 

Live Webinar: Coverage and Optimal Reporting of HCT for 2018

On Thursday, April 19, from 11 a.m. to 12:30 p.m. CDT, our experts will review correct coding of allogeneic stem cell transplants and current reimbursement rates along with claim billing rules for related and unrelated donor expense. We will specifically review what transplant centers need to “self-audit” in terms of correctly prepared claims, including the reporting of all charges, professional services, and submission of cost reporting information for donor search and cell acquisition. At the end of the webinar, Susan Leppke, Director of Public and Payer Policy at NMDP, will review key Medicare coverage changes and provide an update on strategies for expanding Medicare coverage and improving reimbursement. Come prepared with questions to ask during the Q&A session at the end!

Register now for this free webinar.


Where can you find us next?

You can find the NMDP Public and Payer Policy team exhibiting at these conferences:

Essentials of Oncology, Solid Organ and Blood/Marrow Transplant Management for the Health Care Team, April 16-17 in Scottsdale, Ariz.

2018 CMSA Annual Conference & Expo, June 19-23 in Chicago, Ill.

If you are attending, come say hello! We would love to chat with you.


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If you have any questions or need additional information, please contact the Payer Policy team at PayerPolicy@nmdp.org. All of our resources are available on our website: Network.BeTheMatchClinical.org/Reimbursement.

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