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. The Patient Access to Cellular Transplant (PACT) Act S.1286/H.R. 2498 will ensure that providers of services receive adequate payments for the acquisition of bone marrow and cord blood cells under the Medicare program. 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.
We are one step closer to protecting access to blood stem cell transplant for patients.
When we talk about PACT Act, we're talking about lives on the line. Approximately 1,200 Medicare patients a year need a bone marrow or cord blood transplant.
The PACT Act will:
- Improve reimbursement to help cover the cost of transplant
- Align bone marrow transplants with solid organ transplants
- Increase access to bone marrow and cord blood transplants
This bill will do an incredible amount to help more people beat blood cancers and diseases and live longer, better lives.
Read about our PACT Act efforts: In October 2019, we partnered with the American Society for Transplantation and Cellular Therapy (ASTCT) to ask both the House of Representatives Committee on Ways and Means and the Senate Committee on Finance for passage of H.R. 2498/S. 1268, the PACT Act.