Medicare Aims to Expand Coverage of Cancer Care. But Is It Enough?


WASHINGTON — In a major test case, Medicare is poised to cover a promising but expensive new type of cancer treatment, with significant restrictions meant to hold down the cost.

 Cancer patients, doctors and drug companies are urging the Trump administration to remove the restrictions and broaden coverage so more patients can benefit from the treatment, known as CAR T cell therapy, or CAR-T. But insurance companies are pushing for the restrictions.
The treatment is manufactured specifically for each patient, and many more such “personalized medicines” are in the pipeline. Medicare’s final decision, expected in the next few weeks, will influence commercial insurers and state Medicaid programs, which often follow its lead.
Medicare and other insurers typically pay for drugs as they are used, from month to month and year to year. By contrast, the CAR-T treatments generate high costs up front, but the benefits could last for years.

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