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U.S. Medicare Sets Outpatient Rate For Yescarta Reimbursement

(Reuters) Apr 5, 2018 - Medicare, the U.S. government healthcare program for the elderly and disabled, will pay hospitals close to its standard mark-up rate for administering cell therapy Yescarta for cancer outpatients, who will have a co-payment of nearly $80,000, according to the Centers for Medicare & Medicaid Services (CMS).

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Winston Wong, PharmD (Posted: April 09, 2018)

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CMS has set the reimbursement for their near normal outpatient rate, thus CMS is treating the CAR-T therapies as an outlier, since the normal hospital reimbursement would be based upon the DRG. Given the co-pay cap, there seems to be little margin for the institution. Need to watch can see what will happen with the additional service reimbursement request.

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