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Inside Drug Pricing - 05/18/2020

Hospitals Score A Win On CAR-T Cancer Drug Reimbursement

By John Wilkerson / May 12, 2020 at 1:53 PM
Hospitals scored a win Monday (May 11) when CMS proposed a new national unadjusted pay rate for hospitals that administer chimeric antigen receptor T-cell (CAR-T) treatments for cancer that would increase the reimbursement rate. The agency proposed to exclude clinical trial cases and unusually low hospital charges from calculations of the pay rate. CMS proposed creating a so-called MS-DRG (Medicare severity diagnosis related group) for CAR-T and excluding the low charge data from the relative weight, which determines payment for...


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