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Medicare fix is needed to protect access to life-saving transplants.

The number of Medicare-eligible patients receiving a blood or marrow transplant has increased significantly. For the past several years, researchers and healthcare professionals throughout the world have worked hard to find innovative treatments to allow patients fighting a blood cancer or other blood disorder a way to receive a bone marrow, peripheral blood stem cell or cord blood transplant; which in many cases, is the only chance for a cure.

Yet, despite the increase in transplant referrals for Medicare beneficiaries, current Medicare reimbursement payment policy creates an unnecessary barrier for patients who need this potentially curative therapy.

The Commitment: With the establishment of a national bone marrow registry in the mid-1980’s, Congress promised patients with blood cancers, like leukemia and lymphoma, and other life-threatening diseases that they would have a way to find a life-saving donor match.

Today, this national registry (known as the Be The Match® Registry) serves as the single point of access for patients to matched adult volunteer donors, as well as cord blood units.

Physicians rely upon these cells to perform adult stem cell transplants that can cure more than 70 otherwise fatal, diseases or conditions, including blood cancers and sickle cell disease.

The Problem: Medicare rates for hospitals do not cover the cost of providing bone marrow or cord blood transplants. Medicare has not kept pace with advances in treatment that now allow patients 65 years and older, who once were not considered candidates for transplant, the option to receive this curative therapy. Under current law, Medicare combines into a single payment the cost of acquiring cells for transplant along with all of the inpatient costs hospitals incur when providing transplant services during a 20-30 day window. Transplant centers are losing thousands of dollars on each Medicare beneficiary they treat; many can no longer sustain providing these transplants to Medicare beneficiaries.

The Solution: Medicare should reimburse hospitals for the cell acquisition costs using a methodology similar to that used for solid organs. Reps Ron Kind (D-WI), Doris Matsui (D-CA), and Gus Bilirakis (R-FL) introduced The PACT Act last year to ensure that providers of services receive adequate payments for the acquisition of bone marrow and cord blood cells under the Medicare program. With support from lawmakers, we will reintroduce The PACT Act this year. Medicare already reimburses hospitals for the acquisition costs of procuring solid organs – including kidneys from living donors – using standard acquisition charges that reflect hospitals’ average acquisition cost associated with each organ. Health and Humans Services (HHS) implemented this policy to avoid acquisition costs becoming a barrier to transplant. The PACT Act adopts this policy for bone marrow and cord blood. 

Take Action!

Urge your Members of Congress to support legislation to reform Medicare payment policy for bone marrow, peripheral blood stem cell and cord blood transplants. Medicare beneficiaries need your help: be the voice to save a life!

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