CAR-T therapy, also known as CAR T-cell therapy, is a cancer treatment that involves modifying a patient’s own immune cells so that they will fight and kill cancer cells and then reinserting them into the body. These cells are taken from the patient’s blood. CAR stands for chimeric antigen receptor, and this antibody-like protein is injected into the T cells so that it can target cancerous cells throughout the body. Due to the recent national coverage determination decision, CAR-T therapy is now covered for many Medicare recipients nationwide.

What is CAR T-cell Therapy?
CAR-T therapy is a multi-step treatment option that takes weeks to complete. First, T cells are removed from the patient’s blood using a process called apheresis. This is a non-invasive process that involves removing the blood from the body, extracting the T cells from the blood, and then returning the remaining parts of the blood back into the body.

After the T cells have been removed, a chimeric antigen receptor (CAR) protein is inserted on the surface of the cells. The CAR protein is antibody-like, allowing it to bind to certain cells, tagging them and allowing them to be destroyed. After CAR is inserted, the T cells are replicated in a laboratory, creating millions of modified T cells. These cells can then be frozen until they are ready to be inserted back into the patient.

While the cells are being replicated, patients often undergo chemotherapy to continue fighting the cancerous cells. Then, the CAR T cells are re-injected into the person’s bloodstream, where they can continue to multiply. The T cells seek out cancerous cells, recognize them, mark them, and destroy them.

After undergoing therapy, patients must stay in the hospital for about two weeks. They are monitored for any potential side effects. Even after the cancerous cells have been attacked and destroyed, the CAR T cells remain in the body to help prevent cancer reoccurrence, allowing for long-term remission.

Cancer Treatment with CAR-T Therapy
CAR T-cell therapy can be used by most people with acute lymphoblastic leukemia (ALL) and certain types of non-Hodgkin lymphoma. It is used only when traditional therapy options have failed or after relapse has occurred following two unsuccessful treatments. ALL is the most common cancer in children, causing around 80 percent of all cases. Relapses after unsuccessful chemotherapy treatments of ALL are the leading cause of death from childhood cancer, and CAR-T therapy provides a great alternative treatment option.

Until recently, CAR T-cell therapy was only used in clinical trials. However, it has now been approved by the FDA. While only two types of cancers are currently being treated with this therapy, research continues to progress to target other types of cancer effectively.

Do Medicare Benefits Cover CAR T-cell Therapy?
The Centers for Medicare & Medicaid Services (CMS) reached a decision allowing CAR T-cell therapy to be more widely covered by Medicare. Medicare recipients will be able to receive coverage for this type of cancer therapy as long as they are provided in facilities that are approved by and enrolled in the FDA Risk Evaluation and Mitigation Strategies.

This treatment is very expensive, costing $375,000 or $475,000 depending on the type of being treated. Because of this high cost, many medical centers do not offer this treatment. Medicare benefits have also been increased to reimburse 65 percent of the treatment cost, up from 50 percent. This increase improves hospital reimbursement and will likely increase the number of clinics offering this therapy option to patients.

Medicare has agreed to cover the costs as long as the conditions stated above are met. There is also the possibility that outpatient treatments could become available, significantly reducing the associated costs. Since CAR-T therapy must be completed in an inpatient setting, Medicare Part A will cover the costs, requiring only that you cover your deductible and any required annual payments.

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