What Nurses Should Know About the Medicare Coverage of CAR T-Cell Therapy


The Centers for Medicare and Medicaid Services (CMS) announced that it will cover chimeric antigen receptor (CAR) T-cell therapy for Medicare beneficiaries.

The Centers for Medicare and Medicaid Services (CMS) announced that it will cover chimeric antigen receptor (CAR) T-cell therapy for Medicare beneficiaries.

With this, certain criteria must be met; however, the decision now means the therapy will be more widely available to patients with blood cancer.

Oncology Nursing News spoke with American Society of Hematology (ASH) president Roy Silverstein, MD, of the Medical College of Wisconsin, about the implications of CMS’s decision and what this means for oncology nurses.

Oncology Nursing News: Can you explain what this decision means for the treatment of certain blood cancers?

Silverstein: What we think and what we hope is that we will make it easier for patients to access these therapies. One of the problems right now in our field is that we’ve developed these exciting new drugs and cellular therapies, but because of the reimbursement issues and expense, they are not as widely available as we would like for many patients who could benefit from them and don’t have access to them. So, what we are hoping is that by CMS changing their rules, it will open up more sites to deliver these therapies.

Are there any challenges we should be aware of?

One of the hurdles we were dealing with is the financial hurdle. These are expensive therapies, both the actual treatment itself as well as the care of the patient who is receiving the drug. We are hopeful that CMS will develop a protocol or method to properly reimburse hospitals and health systems for the costs of these drugs. We think that some progress was made. It’s not as far as we would have liked, but they have made some progress and we will make more medical centers make these therapies available. Hopefully as we learn more about them and CMS learns more about them, we’ll work together to help them develop more modern methods for reimbursing for these new kinds of drugs. We hope that this will continue to improve.

How can nurses, or nurse navigators, now play a role with this decision?

One of the issues is connecting the patient to the centers that can deliver the drug, and this is where nurse navigators who are working in partnership with health centers can help the patient.

The care of these patients is extremely nurse-dependent — as is the care for all patients. Since these patients spend a significant period of time in the hospital, they get a very unique set of side effects, called cytokine release syndrome. It is somewhat similar to when patients get a bone marrow transplant or other forms of immunotherapies, so specialized nursing is a really big part of the treatment of these patients. From the beginning, when the cells are removed from the patient for processing – that is a nurse-driven technology – to reinfusing the cells back into the patient when the cells are ready 6 weeks later, and then to the care of the patient as they navigate through the complicated side effects that are often seen. Fortunately, most patients make it through the side effects and do quite well, but it is a rigorous period of weeks after the infusion of the drug that the patient has to go through.

Is there anything in particular nurses should know about this decision when guiding patients?

There will be more health systems offering this treatment, so nurses probably need to be aware — in particular cancer center nurses or oncology nurses – that they may be seeing this in their own health systems if they haven’t seen it yet. For those nurses who are involved in caring for cancer patients who might benefit from these drugs – right now that is primarily in patients with B-cell malignancies like acute leukemia, lymphoma, and multiple myeloma – and may be eligible in the right circumstances, probably would benefit from knowing that and being able to communicate with patients about that.

Is there anything we haven’t touched upon that nurses should know more about?

These therapies are so exciting, and they’ve been a true breakthrough for treating patients with blood cancers. In the future, we hope that they develop these drugs for other kinds of cancers as well. So, we are extremely excited about these therapies and really hopeful that CMS will continue to work with the professional organizations, like ASH, and the health systems to develop more modern and creative ways to reimburse the health systems for the care of these patients that receive these treatments.

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