Medicare would cover CAR-T cell therapies under new CMS proposal

A new proposal from the Centers for Medicare & Medicaid Services would have Medicare cover FDA-approved CAR T-cell therapies, according to a Friday announcement from the agency. CAR T-cell therapy is a new form of cancer therapy that harnesses a patient’s own immune system to fight the disease. There are currently only two approved CAR-T cell therapies, Novartis’s NVS, +0.65% Kymriah and Gilead Sciences Inc.’s GILD, +1.39% Yescarta, but they are prohibitively expensive, costing as much as $475,000. There is no national Medicare policy for covering the expensive new cancer treatment, so local Medicare administrative contractors decide whether to pay for it. Under CMS’s proposal, Medicare would cover FDA-approved CAR-T therapies for patients as long as patients are monitored for at least two years post-treatment, and CMS will use that data to decide which treatments to fund in the future. "Today’s proposed coverage decision would improve access to this therapy while deepening CMS’s understanding of how patients in Medicare respond to it, so the agency can ensure that it is paying for CAR T-cell therapy for cases in which the benefits outweigh the risks," said CMS Administrator Seema Varma. Shares of Novartis have gained 4.3% in the year to date, while shares of Gilead have gained 6.3%. The SPDR S&P Pharmaceuticals ETF XPH, +1.07% has gaiend 13.5% and the S&P 500 SPX, +0.84% has gained 10.4%.

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