By Stephanie Farnia, ASBMT Director of Health Policy and Strategic Relations
New Year, Same Goals
As some of you are well aware, the start of a new year brings fresh starts, resolutions and…an ever-growing feeling of a generalized dread as the Tandem deadlines that were once far off are now just around the corner. The official medical term for this feeling is Panic at the Disco and the only real treatment is to carve out time to download all those vague, swirling ideas about your presentation, poster or committee materials into an actual usable format – an activity that is always easier said than done. (The good news is that one’s motivation tends to increase when the only other alternative is to attempt to chisel the ice from your driveway when the temperature is -5° F.) As I have begun stumbling through my Tandem preparations, it became clear that while we do have new areas of access and reimbursement issues to pursue, much of our focus this year will be on finishing what we have started – i.e. moving current initiatives from the half-way point to the finish line. A brief summary of these focus areas is below and I will highlight sessions at Tandem that plan to discuss these issues in more detail in February’s column. Finally – I listed a few articles and podcasts that I found particularly helpful recently at the end of the column. I will try to do the same thing in future months.
HCT: 2018 will be heavily focused on pushing HR 4215 into legislative reality and on improving coverage of necessary indications for those Medicare beneficiaries needing HCT. The ASBMT will continue to work closely with NMDP/Be The Match on these efforts and support their active efforts on the Hill to secure separate reimbursement for donor acquisition costs. If you have not submitted a request to your Congressional representative, it is definitely not too late – the Hill will soon begin taking up discussion of a number of issues that were set aside in order to handle the tax bill. The Be The Match team has made it easy to send in your comments via this link.
CAR-T: A primary focus for 2018 will continue to be working to improve Medicare reimbursement for CAR-T when it is provided in the inpatient setting. The ASBMT has arranged a series of calls between various CMS/CMMI staff and clinical programs currently providing CAR-T, with the hope of partnering on a solution earlier than the beginning of the FY2019 payment year. On the coding front, as reported previously, the ASBMT has submitted requests for new CPT codes for CAR-T to the American Medical Association. We are currently on the docket for the February CPT meetingand are awaiting comments from our application’s reviewers. If the comments warrant additional work, the codes may be moved to the May 2018 meeting. In either case, the codes are still within the 2020 coding cycle. Additionally, we expect that both Kite Pharma and Novartis have applied for CMS’ New Technology Add-on Payment (an additional temporary payment on top of the MS-DRG) for Fiscal Year 2019, which begins October 1, 2018. CMS will be holding a public meeting to discuss the applications and receive public comments on the morning of February 13, 2018. The meeting is public and can be joined in person (pre-registration required) or via live stream.
Podcasts: For those of you that need a screen break or are trying to find a way to make your time on the treadmill go a bit faster, podcasts are a great way to get a more in-depth understanding of an issue. I’ve been turning to these far more often lately, so tweet me @HCT_policy if I missed a series that you really enjoyed.
- Radiolab November 9, 2017 episode – Match Made in Marrow: A great special feature on the Be The Match registry, including insight from CIBMTR’s Steve Spellman.
- Radio Times (WHYY) August 31, 2017 episode – Advances in Cancer Treatment: A podcast featuring the UPenn team just after the approval of Novartis’ Kymriah.
- POLITICO Pulse Check: Weekly in-depth discussions on health policy issues with guest experts. These podcasts usually outlive their publication date, so it’s worth digging back in the archives for topics of interest.
- POLITICO Playbook Audio Briefing: A 2-5 minute general daily update on the hottest topics of the day on the Hill.
Reading Round-up:
- Spark Therapeutics announced a price of $850,000 for their newly approved gene therapy, along with three new payment programs. These will be crucial to watch for potential roll-over to other high cost therapies like CAR-T.
- Harvard Business Review provided an analysis of how the tax bill will affect health care.
- A NYT piece on the issues preventing passage of long-term extending funding for the CHIP program.
- ACA enrollment numbers for 2018 are high, despite limited promotion and a shortened window to sign-up.
- Even those that only occasionally read about health economics likely recognize the name of Uwe Reinhardt, who passed away in November. His obituary in the NYT outlined how his work and life impacted how we evaluate the costs of health care in both a local and global manner.
I wish you all the best of luck in your Tandem preparations – and in your avoidance of frozen driveways. As always, email me at StephanieFarnia@asbmt.org with any questions or concerns.
Back to the January 2018 issue of eNews.