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Medicare to Cover CAR-T Therapies

The Centers for Medicare & Medicaid Services announced yesterday that it would be covering approved CAR-T therapies for Medicare patients, the Associated Press reports.

The US Food and Drug Administration approved Novartis' CAR-T therapy Kymriah about two years ago to treat a form of acute lymphoblastic leukemia and shortly thereafter approved Kite Pharmaceuticals' Yescarta, another CAR-T therapy, this one for certain types of large B-cell lymphoma. But both therapies came with hefty price tags — Kymriah comes in at $475,000 and Yescarta at  $373,000 — and that has led to concerns about how health insurers, particularly in the US, would pay for treatment.

In its announcement, CMS says it will cover CAR-T therapies when they are given at healthcare facilities that are enrolled in an FDA risk evaluation and mitigation strategy program and when given for approved indications. It also says it will cover their off-label use if such a use is recommended by CMS-approved compendia.

As the AP notes, CMS "often sets the tone for private insurance as well."

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