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Dr Thomas Marsland on CMS' CAR T-Cell Therapy Reimbursement Plan

Thomas Marsland, MD, medical oncologist, discusses his take on the CAR T-cell therapy reimbursement plan put forward by CMS. 

Thomas Marsland, MD, medical oncologist, discusses his take on the CAR T-cell therapy reimbursement plan put forward by CMS. 


What are your thoughts about the [chimeric antigen receptor] CAR T-cell therapy reimbursement plan introduced by CMS? Will it help or hurt patient access to these life-saving therapies?

Just to make a couple generic comments, there’s an old saying that ‘be careful what you ask for.’ I was the care advisory committee representative for years and looked at local coverage determinations. So, I think, we take that with a little bit of salt– local coverage determinations and for that matter national coverage determinations– sort of set the ground rules as to exactly what it is. And you know, it also limits in many ways. I think the concerns are that this national coverage determination for CAR T cells may, in some ways at least, be too narrow or too restrictive in the sense that it limits it to just certain institutions. As I said, I don’t ever see CAR T cells as being something that every medical oncologist is going to be doing. There are certainly big practices in private communities and private practices that potentially have the capabilities of doing that.

One of the other concerns with that national coverage determination was that it limited off-label coverage just to one of the compendia whereas historically we’ve always used off-label coverages for several compendia that we’ve been allowed to use. So, I think that’s a bit of a concern.

The coverage with evidence-based determination is, I think, a good thing. I lived through that with [positron emission tomography] PET scanning and prostate cancer and I think that was a wise thing that CMS did to do that, and they came out with policy after that that I think was appropriate.

The concern there though is that the reporting burden for this may be a little bit too great for some of the things and they’re maybe asking and expecting too much to be reported. It’s that administrative work that then becomes prohibitive sometimes. I mean, there’s already a lot of administrative burdens that we’re facing, and any more paperwork would not be a good thing. 

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