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Slow Coverage

Though two CAR-T cell therapies have received US Food and Drug Administration approval, NPR reports that government and private insurers are being slow to cover the drugs.

FDA approved Novartis' Kymriah nearly a year ago to treat a form of acute lymphoblastic leukemia and Kite Pharmaceuticals' Yescarta last October for certain types of large B-cell lymphoma. But both drug are pricy: Kymriah reportedly costs $475,000 and the list price for Yescarta is $373,000. The drug companies, though, have said they are exploring alternative payment schemes, such as based on how well the treatment works.

These prices have led government and private insurers to hesitate, NPR reports. It says that while most large commercial insurers do cover the treatments, it's on an individual basis, as they write agreements with single patients. Smaller insurers, though, are less experienced with complicated therapies, which NPR says can lead to delays in approval.

But, it says government insurers are more challenging. According to NPR, some state Medicaid programs, grappling with tight budgets, deny coverage, while Medicare has said it would cover it as outpatient treatments, though it is currently given as an inpatient treatment because of side effect concerns.