Medicare sets hospital outpatient payments for lymphoma drugs: 5 things to know

Medicare has established the outpatient reimbursement rates for Gilead Science's and Norvartis' respective lymphoma treatments, according to a Reuters report.

Here are five things to know.

1. The FDA initially approved Yescarta from Gilead Science in October and Novartis' Kymriah in August. Kymriah is approved for patients up to 25 years old with relapsed acute lymphoblastic leukemia, while Yescarta is approved for adults with large B-cell lymphoma.

2. CMS said the outpatient Medicare reimbursement rate for hospitals now administering Yescarta is near its standard mark-up rate at $395,380, with a $373,000 list price, according to the report. The copay for Yescarta is at least $79,076.

3. Medicare set the outpatient reimbursement rate for Kymriah at $500,839, with a $475,000 list price, reports Reuters.

4. For inpatients, the makers of both drugs are asking for additional Medicare reimbursement. This would be in the form of "new technology add-on payments," the report states.

5. CMS told Reuters via email no decision has been made regarding the requests.

Read the full report here

 

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