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Bone marrow and cord blood transplants can be used to successfully treat more than 70 diseases and conditions. Many times transplant is a patient’s only hope for a cure.

Commercial insurance covers transplants for most, if not all, of these 70 diseases. However, the Medicare program, which provides insurance to those 65 years and older and those with a long-term/permanent disability, does not. This means that if someone develops a disease or condition when 65 years old or older, he or she may not have access to a life-saving transplant.

One of the greatest challenges we face is making sure patients who are Medicare or Medicaid beneficiaries, as well as those enrolled in Marketplace Exchange plans, have the same access to transplant as those who rely on commercial insurance. 

Medicare reimbursement

For transplants that Medicare covers, the amount reimbursed to the hospital or transplant center is less than the cost of providing the service. This is because current reimbursement rates do not cover the cost of finding a marrow donor or getting the cells needed for transplant. 

Patient access to life-saving bone marrow and cord blood transplants is a top priority for Be The Match. We work closely with private insurers and government insurance programs like Medicare and Medicaid to ensure access to treatment for all patients. Inadequate Medicare transplants reimbursement, primarily for donor related costs, poses a significant barrier to patient access. 

Be The Match has met with Medicare to present the challenges transplant centers face with reimbursement and we proposed a solution to the problem. Our recommendation was to reimburse transplants in the same way solid organ transplant are reimbursed. Medicare pays for donor-related costs separately for solid organ transplants. Medicare recently released the proposed inpatient payment rule for FY2019 and we were hoping to see a change in the way donor related costs are paid for by Medicare but unfortunately those changes were not included in the proposed rule. Please see the National Marrow Donor Program’s comment on the rule.

Two Paths, One Goal

NMDP’s Public & Payer Policy team is committed to securing a solution to this patient access barrier. We have had many discussions with CMS around a fixing this issue that would mirror the way solid organ reimbursement is structured.  At the same time, four Members of Congress have introduced a bill, HR 4215 “Protect Access to Cellular Transplant(PACT) Act”  that currently has 22 co-sponsors and strong support from our grassroots advocates.    

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