Medicare Poised to Cover CAR T Cancer Therapy

Updated April 18, 2019

There's no denying that cancer treatments are expensive, they cost insurance companies and patients more than a pretty penny each year. Add in unconventional treatments and the price skyrockets even more. Medicare is looking to expand options, though, starting with CAR T-cell therapy. Under the Trump administration, a proposal could help those who have cancer that has persisted despite treatments.

What's in this Guide?

Disclaimer: Before You Read

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CAR T Explained

CAR T is an innovative way for physicians to help patients fight cancer. It involves extracting T cells, also known as immune cells, from the patient's blood and sending them to a lab. In the laboratory, technicians take these cells and genetically engineer them so that they're able to identify and attack the cancer cells.

After they're engineered, they're sent back to the hospital and then given to the patient via transfusion. The idea is to make a person's cells work for their body instead of against it by giving the T cells directions to fight the invasive cancer cells.

Medicare to Foot Some of the Cost

Where typically Medicare doesn't cover experimental treatments, the proposal submitted gets the insurance program onboard — helping patients afford what might be their best shot at surviving the oftentimes deadly disease.

However, there will be restrictions placed on the therapy. Not everyone who has cancer will be eligible. Hospitals have to be 100% involved in the treatment, meaning that they have to agree to enroll patients in a "study" of sorts, continue to monitor them and report on their continuing quality of life for at least 2 years post-treatment.

The Conflict

Of course, there's always a conflict when it comes to what insurance companies should cover and how they should pay for it. According to The New York Times, some of the largest insurance companies, such as UnitedHealthcare, are asking for restrictions on who receives and how the therapy is administered, because there is a significant financial risk.

This is only one side of the coin, though. Caretakers, scientists, doctors and even advocates for the American Cancer Society say the therapy could be a real game-changer for many patients and putting endless restrictions on the treatment could do more harm than good. It shouldn't be restricted to patients who have either not responded or had a relapse after receiving chemotherapy.

The one thing that all parties can agree on, however, is that there needs to be more specialized treatment that helps those suffering. It's just a matter of how to implement the restrictions, if any, and reach as many patients as possible.

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