Bloomberg Law
Free Newsletter Sign Up
Login
BROWSE
Bloomberg Law
Welcome
Login
Advanced Search Go
Free Newsletter Sign Up

Private Insurers Use Creative Payment Models for Pricey Therapies

Aug. 27, 2019, 9:18 AM

Medicare’s recent decision to guarantee government coverage of breakthrough cancer treatments is spurring a different reaction from private insurers: They are likely to rely on creative payment models to finance the costly therapies.

The Centers for Medicare & Medicaid Services will offer uniform national coverage for Yescarta by Gilead Sciences Inc. and Kymriah by Novartis AG beginning Oct. 1, 2020. The two therapies are the only FDA-approved “CAR T-cell” therapies to treat lymphoma and leukemia. The treatment uses a patient’s genetically modified immune cells to fight the illness. The government now covers the treatment on a case-by-case basis.

Despite advances ...