Coverage Now Available for Groundbreaking New Cancer Treatment

We are proud to offer coverage for a new cancer treatment known as CAR-T therapy

October 01, 2018  

We want to make sure the latest medical innovations are available to our Commercial members, especially those battling cancer. That’s why we’re proud to offer coverage for a new cancer treatment known as CAR-T therapy.

CAR-T is a cell therapy for patients with cancers that include:

  • Childhood B-cell acute lymphoblastic leukemia
  • Adult patients with relapsed or refractory large B-cell lymphoma
  • Aggressive B-cell non-Hodgkin’s lymphoma in adults for whom other treatment options have failed

Last year the U.S. Food and Drug Administration approved two CAR-T therapies: tisagenlecleucel (Kymriah™, Novartis) and axicabtagene ciloleucel (Yescarta™, Gilead). Currently these therapies can be administered only in select hospitals in a few cities, including Boston.

We anticipated that CAR-T therapies would become available and built coverage for them into our rates. To limit the rate impact, we’ve negotiated the best possible price with network hospitals that provide the treatment.

CAR-T therapy involves cell engineering, which is currently priced in the $400,000-$500,000 range. This cost does not include the patient’s hospitalization, chemotherapy and other services, which can add several hundred thousand dollars more to the total.

We’re also working with the hospitals to make sure members receive treatment promptly when appropriate. Our medical policy team has published criteria under which these therapies will be covered. A separate core team has also been set up to evaluate prior authorization requests as they come in.

How It Works

CAR-T therapy uses a patient’s own immune system to fight cancer. It involves collecting a patient's T-cells (immune cells) and shipping them to a facility that genetically modifies them into chimeric antigen receptor (CAR)-T cells. The manufacturing process typically takes two to three weeks, during which time patients receive chemotherapy treatment.

Once the CAR-T cells are prepared, they are infused back into the bloodstream to fight the cancer. These cells stay in the body and keep killing cancer cells. That's why CAR-T therapy is frequently called a "living drug."

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