Indiana’s members of the U.S. House of Representatives have signed on to a letter urging the Centers for Medicare and Medicaid Services to act now and create a billing code for an immunotherapy treatment for cancer patients.  

Representatives Susan W. Brooks (R-IN-05) and Larry Bucshon (R-IN-08) joined their colleagues by signing onto a letter asking CMS Administrator Seema Verma to act for the 2021 fiscal year.

In the letter to CMS Administrator Seema Verma, legislators wrote that “rural patients already face potential access challenges due to their lack of immediate proximity to authorized treatment centers and highlights the importance of maintaining access to those facilities located within reasonable proximity that can provide this therapy to neighboring rural areas.”  They do note that for hospitals that treat large numbers of Medicare patients, the reimbursement gap will be problematic.

“Establishing an MS-DRG for FY 2021 will be an important step to improve access for Medicare patients in need of cancer treatment regardless of where they live,” legislators wrote.  

The chimeric antigen receptor T-cell (CAR T-cell) therapy is an expensive, one- time infusion of cells that fight blood cancers. In the CMS systems, the treatment is subject to an add-on payment for new technology, because the tech used in this treatment has a higher cost than other diseases that the CAR-T cell treatment is used for. That treatment is estimated at $400,000, and entire courses of treatment, including hospital costs, can reach p to $1.5 million.

The letter was signed by 76 legislators in the House of Representatives. It tells CMS that failing to create a permanent payment mechanism for CAR-T treatment, it could mean that patients who need it can’t get it. Especially in the rural areas, where Medicare beneficiaries can find it tough to find a healthcare facility that administers the treatment. 

Legislators praised the CMS decision to give a National Coverage Determination, as a “monumental first step in providing access to these revolutionary medicines to Medicare patients."