Hospitals shell out millions for CAR-T, but aren't getting paid

Hospitals around the country have been jumping at the opportunity to offer patients CAR-T therapy, an often last-ditch effort to fight cancer. While the cutting-edge therapy has shown a lot of promise to save lives, it also leaves hospitals grappling with financial uncertainty, according to a STAT news report.

CAR-T therapy, which uses patients' genetically modified immune cells to fight cancer, has been on the market for more than a year. However, Medicare is still establishing a payment plan for the therapy, and private insurers often enter into one-off billing arrangements with hospitals that  take months to settle.

CAR-T therapies cost hundreds of thousands of dollars and hospitals still don't know if they'll be reimbursed enough to cover their expenses.

Virginia Commonwealth University Massey Cancer Center in Richmond has been treating patients with CAR-T therapy since August.

Penny Trentham, vice president of managed care and payer relations at VCU Health, told STAT that the hospital is still waiting for for insurers to pay the bill for the four patients they've treated with CAR-T.

"We've not been paid on those, and it's been several months," Ms. Trentham told STAT. "It doesn't mean there's a problem, necessarily. These are very complex claims. But we have not been paid."

She added that VCU Health is missing about $1 million from unpaid CAR-T bills and isn't sure if the hospital will even break even when insurers do pay.

The uncertainty comes because this treatment is new and at such a high price point.

"It's just really hard right now, and I think everybody's asking for specific answers, but until we get more experience with this treatment protocol, it's hard to say that we would be willing to accept as a defined payment term," Ms. Trentham told STAT. "Literally, you should do hundreds of cases before you draw a conclusion."

Read the full report here.


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