Bipartisan legislation would eliminate Medicare payment barrier to the curative 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 Senators for introducing the Patient Access to Cellular Therapy (PACT) Act (S. 1268) 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. Senators Debbie Stabenow (D-MI), Richard Burr (R-NC), Sherrod Brown (D-OH), and Tim Scott (R-SC) introduced the legislation.
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.
“Medicare patients are now benefiting from lifesaving bone marrow and stem cell transplants that weren’t possible years ago,” said Senator Debbie Stabenow. “It’s critical that we act to modernize the payments system for these patients so they can have access to these critical treatments.”
“Americans suffering from life-threatening blood diseases shouldn’t be deprived of treatment just because Medicare’s reimbursement process is complicated and bureaucratic,” said Senator Richard Burr. “That is why I am proud to work with my colleagues on this legislation that will remove unnecessary barriers and make sure folks on Medicare, including our seniors, have access to these life-saving innovations.”
“The PACT Act provides hope to the many Americans who suffer from diseases like leukemia and lymphoma and have struggled to access the care they need. As bipartisan champions for these patients, we urge our colleagues to support the PACT Act so these vulnerable patients can access the care they need to survive,” said Senator Sherrod Brown.
“We owe it to folks with sickle cell disease and other rare blood-related diseases to remove barriers in the Medicare reimbursement system that make it difficult for many Americans to access the care they need to live. The PACT Act will make it easier for them to receive these curative treatments,” added Senator Tim Scott.
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 to ensure 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 the cost of search and cell acquisition for blood cancer patients. Moreover, as patients recover from lifesaving procedures—requiring a 20- to 30-day hospital stay on average—hospitals take huge financial hits because 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 Senate for introducing the PACT Act,” said C. Randal Mills, Ph.D., Chief Executive Officer of NMDP/Be The Match. “We urge lawmakers in both houses 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 transplant 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.