By
C. Randal Mills
May 14, 2019 at 5:00 am ET
A cure for blood cancer exists. Sadly, that doesn’t mean Medicare patients can access these life-saving treatments.
Medicare patients with blood cancers like leukemia and lymphoma, or blood diseases like sickle cell, live knowing that cellular transplants—an umbrella term for transplanting bone marrow, peripheral blood stem cells or cord blood units—can be the only curative therapies that will save their lives.
Under current policy, hospitals lose tens of thousands of dollars on each cellular transplant for Medicare beneficiaries. Unlike the process for covering solid organ transplants, Medicare lumps payments into a single Medical Severity Diagnosis Related Grouping (MS-DRG). This single payment reimburses hospitals for the costs associated with acquiring bone marrow or cord blood, performing the transplant and treating recovering patients during the average 20- to 30-day hospital stay. Conversely, the Centers for Medicare and Medicaid Services (CMS) consistently pay separately for solid organ acquisition costs.
Proving that bipartisanship is still very much alive in Washington, a group of congressional leaders on both sides of the aisle have come together to introduce the Patient Access to Cellular Therapy (PACT) Act (S. 1268/H.R. 2498), which would expand Medicare beneficiaries’ access to cellular transplants, the only curative treatments for patients with blood cancers like leukemia and lymphoma.
Representatives Ron Kind (D-WI), Kenny Marchant (R-TX), Doris Matsui (D-CA) and Gus Bilirakis (R-FL) sponsored the bill in the House, while Senators Debbie Stabenow (D-MI), Richard Burr (R-NC), Sherrod Brown (D-OH) and Tim Scott (R-SC) introduced the legislation in the Senate.
The bill will allow Medicare to adequately reimburse hospitals for the cost of identifying suitable donors, acquiring and transporting bone marrow and performing life-saving cellular transplants. It will also allow Medicare to cover patients’ hospital stays while recovering from their procedures. By aligning reimbursement for cellular transplants with that of solid organ transplants, Congress has the opportunity to incentivize more hospitals to give the gift of life to thousands of Medicare beneficiaries with blood cancers.
The National Marrow Donor Program® (NMDP)/Be The Match® exists to help patients in the search for a match. NMDP/Be The Match has facilitated more than 92,000 transplants between donors and patients during the past 30 years. Unfortunately for current Medicare patients, even when the perfect donor is identified, it is increasingly difficult to access care due in part to outdated reimbursement regulations that make it virtually impossible for hospitals to cover the cost of providing cellular transplants. With appropriate policies put in place, Medicare patients will no longer be at risk, allowing them to live longer, healthier lives.
I urge Congress to swiftly pass the bipartisan PACT Act so patients with life-threatening blood diseases can focus more on winning the fight over cancer instead of the fight over access. Making cellular transplants more accessible is not a political game—it is the right thing to do.
C. Randal Mills, Ph.D., is the Chief Executive Officer of NMDP/Be The Match.
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