The Alliance for Regenerative Medicine (ARM) applauds the Centers for Medicare and Medicaid Services’ (CMS) decision to finalize a new diagnosis-related group (DRG) for chimeric antigen receptor T cell (CAR-T) therapies in their FY21 Inpatient Prospective Payment System (IPPS) rule. This is a crucial step forward for patient access to life-changing therapies, and the result of multi-year collaboration among ARM, its members, regulators, and a diverse group of other stakeholders.
CAR-T therapies provide an unprecedented therapeutic benefit to patients with severe blood cancers. Under the current reimbursement system, providers can lose more than $50,000 when administering CAR-T to Medicare patients. By finalizing this provision, CMS has signaled their commitment to appropriately and sustainably reimbursing Medicare providers for administering these life-saving therapies, and in doing so, promoting broader patient access.
ARM CEO Janet Lambert comments, “The creation of a new DRG for CAR-T therapies has been a key priority for ARM since 2018. As the voice of the cell and gene sector, ARM partnered with policymakers and key industry and provider groups to see this goal realized. With durable and sometimes curative therapies near at hand for a range of severe diseases and disorders, CMS’ decision was the right one — ensuring patients will have access to this next generation of transformative therapies.”