CAR-T cell therapy is considered as a powerful and beneficial weapon for "clearing" cancer cells. Since its debut in 2017, the high expense of this therapy has caught the public’s attention. To ease the financial burden of patients and their families, a number of countries have explored the feasibility of medical insurance coverage of CAR-T treatment costs.

Recently, the Centers for Medicare and Medicaid Services (CMS) announced that they will not only pay for the cost of CAR-T cell therapy, but also pay for all related services, including drug management, cell collection and processing, cell return, and outpatient or inpatient services. Previously, on May 16, 2018, the Centers for Medicare and Medicaid Services (CMS) officially accepted the request for including chimeric antigen receptor CAR-T cell therapy into medical insurance. On February 15, 2019, CMS officially issued a proposed decision memorandum: Approving CAR-T cell therapy for formal inclusion in health care.

In this proposed MOU (memorandum of understanding), Medicare is assigned the role to provide nationwide coverage in CMS-approved studies and to monitor patients for at least two years after treatment. The monitoring data obtained will also help CMS provide critical and decisive information for the subsequent advancement of Medicare coverage treatment.

This policy may be a positive sign for the hospital, which previously was reluctant to adopt the therapy as a result of the lack of clear rules for Medicare and Medicaid services, as well as the high price of these treatments. According to the officials, when these therapies are provided in a medical institution registered with the FDA Risk Assessment and Mitigation Strategy (REMS) and the indications are also FDA-approved, medical insurance will cover them. Moreover, Medicare will cover FDA-approved treatments for indications other than the instructions.

Previously, in April 2018, the US CMS (Medical Insurance and Medicaid Service Center) announced that it agreed to pay for the high cost of CAR-T therapy. Specifically, if treated outside the hospital, CMS pays approximately $500,000 for patients receiving Kymriah treatment and approximately $400,000 for patients receiving Yescarta treatment, and patients only pay 20%. At the same time, if it is hospitalization, plus the consideration of side-effect maintenance treatment, the maximum subsidy can reach 1.5 million US dollars. The introduction of this policy will definitely increase the accessibility of CAR-T drugs.

However, even though medical institutions have proposed various subsidy policies, the high price of CAR-T drugs is still unacceptable. The US Medicare and Medicaid Service Center (CMS) announced that it will not only pay for CAR-T cell therapy, but also pay for all related services, including drug management, cell collection and handling, cell return, and outpatient or inpatient treatment costs, which further reduces the cost of CAR-T therapy.

Conclusion

In general, the cost of the entire CAR-T treatment focuses on two aspects: fist, the production costs of the drug; second, the cost of maintenance treatment. Since the cost of treatment for CAR-T therapy has been covered, and its manufacturing costs and pre-research and development costs have become the focus of attention. At present, the manufacturing costs and pre-research and development costs have led to the still high cost of CAR-T therapy. Many pharmaceutical companies and R&D institutions have realized that reducing costs by improving automated CAR-T preparation would be an effective way.

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