Bipartisan legislation would eliminate Medicare payment barrier to the curative cellular therapy option by aligning bone marrow, peripheral blood stem cell and cord blood transplant reimbursement with Medicare payment policies used for solid organ transplant

May 05 2019

National Marrow Donor Program® (NMDP)/Be The Match® today commended a bipartisan group of lawmakers in the U.S. House of Representatives for introducing the Patient Access to Cellular Therapy (PACT) Act (H.R. 2498) to expand Medicare beneficiaries’ access to cellular transplants, which can be the only curative treatments for blood cancers such as leukemia or lymphoma and other blood diseases. Representatives Ron Kind (WI-03), Kenny Marchant (TX-24), Gus Bilirakis (FL-12) and Doris Matsui (CA-06) introduced the bill in the House.

Senators Debbie Stabenow (D-MI), Richard Burr (R-NC), Sherrod Brown (D-OH), and Tim Scott (R-SC) also introduced the bill in the Senate last week (S. 1268).

If enacted, the PACT Act would require Medicare to adequately reimburse hospitals for the cost to identify genetically matched donors, acquire and transport bone marrow, and perform life-saving cellular transplants. 

“By making it easier for Medicare patients with leukemia, lymphoma, and other serious blood diseases to access lifesaving cord blood and bone marrow transplants, the PACT Act will save thousands of lives and provide hope to vulnerable Americans across the country,” said Representative Ron Kind. 
““By reforming Medicare reimbursement policy to treat cord blood and bone marrow transplants the same as solid organ transplants, the PACT Act will help make it easier for extremely sick patients to access the treatments that will cure them and save their lives. I am honored to stand with my colleagues in Congress and sponsor this critical pro-patient legislation,” said Representative Kenny Marchant.

“The PACT Act is a symbol of hope for the millions of Americans with cancers of the blood like leukemia and lymphoma. By reforming Medicare reimbursement policy to treat cord blood and bone marrow transplants the same as solid organ transplants, the PACT Act will help make it easier for extremely sick patients to access the treatments that will cure them and save their lives,” said Congresswoman Doris Matsui.

"Today, we want seniors battling blood cancers to know that Congress strongly supports the PACT Act, which will make it easier for more older Americans to access the lifesaving, curative treatments they need. By removing barriers in the Medicare reimbursement system, this critical piece of legislation will help patients receive the cord blood and bone marrow transplants that will save their lives,” added Representative Gus Bilirakis.

Patient access to life-saving bone marrow and cord blood transplants is the NMDP/Be The Match’s top priority. The organization works closely with public and private insurers, so all patients have equal access to treatment. Inadequate Medicare transplant reimbursement, primarily for donor-related costs, poses a significant barrier to patient access. 

Currently, Medicare does not cover search and cell acquisition costs for blood cancer patients. As patients recover from these lifesaving procedures—requiring a 20- to 30-day hospital stay on average—hospitals take huge financial hits as Medicare’s reimbursement rate does not come close to covering the true cost of treatment. 

“Cellular transplants have been a game changer in cancer care for Medicare beneficiaries, and it’s crucial that payment policy is updated to support access to this treatment. We applaud the bipartisan champions in the House for introducing the PACT Act,” said C. Randal Mills, Ph.D., Chief Executive Officer of NMDP/Be The Match. “We urge lawmakers in both chambers to act quickly to pass the PACT Act so that more Medicare patients with life-threatening diseases have the opportunity to receive the necessary treatments to cure them.”

While the current Medicare inpatient base reimbursement rate is slightly more than $62,000, the cost of cell acquisition takes a significant portion of this reimbursement, leaving little available for patient care. 

As medical science has advanced to make these life-saving bone marrow, peripheral blood stem and cord blood transplants an option for patients 65 years and older, hospitals cannot afford to absorb the significant losses they incur from the current reimbursement rate for Medicare beneficiaries. Yet, these transplants are often the only curative option for these patients.  

NMDP/Be The Match urges Congress to act quickly to ensure the PACT Act is implemented for calendar year 2020 and that no Medicare beneficiary is at risk for not getting the bone marrow, peripheral blood stem cell or cord blood transplant he or she needs to survive. 

About Be The Match^®
For people with life-threatening blood cancers—like leukemia andlymphoma—or other diseases, a cure exists. Be The Match connects patients withtheir donor match for a life-saving marrow or umbilical cord blood transplant.People can contribute to the cure as a member of the Be The Match Registry^®,financial contributor or volunteer. Be The Match provides patients and theirfamilies one-on-one support, education, and guidance before, during andafter transplant.

Be The Match is operated by the National Marrow Donor Program^®(NMDP), a nonprofit organization that matches patients with donors, educateshealth care professionals and conducts research through its research program,CIBMTR^® (Center for International Blood and Marrow TransplantResearch^®), so more lives can be saved. To learn more about thecure, visit BeTheMatch.org or call 1 (800) MARROW-2.