Genetics based medicine, T-Cell Replacement therapies are miracles, when all else fails they can bring a dying person back to life. The problem is the cost, they are expensive, very expensive. The cost of treating one patient could be as high as $1,000,000.
Ethics, Morality and Money.
One of the first patients ever to receive the treatment called CAR-T was a patient from Florida, Martin Fries, 62, of Kissimmee, FL. His insurance company United Healthcare, Moffitt Cancer Center in Tampa and the drug manufacturer, Gilead, reached a deal to cut down the cost of the treatment.
He was admitted to the hospital and he went through a battery of tests, then Martin Fries’s own cells were extracted, sent to the lab, where the cells were ‘weaponized’ then put back in to hunt down cancer cells and kill them dead.
After 13 days he was declared ‘cancer free’ and he went back to work! Just like that a Million Dollar miracle has happened, now the question is, is this feasible for everyone, can anyone who needs the treatment can get it, and who will pay for it.
So far, few patients have received the new drugs, as commercial health plans and Medicare cover treatment on a case-by-case basis until they can settle on an official payment plan.
Traditionally, hospitals get a lump sum for care they give in the hospital, including drugs, or a payment for outpatient infusing of a drug that covers extra costs. But hospitals say neither of those pay enough to cover their tab for drugs like CAR-T therapies.
“What is the incentive then for hospitals to provide these therapies, which are complicated and require a large investment of time and resources, if there is not a way to at least recoup costs?” says Aaron Chrisman, director of Stem Cell Transplant and Cellular Therapy Administration at the University of Chicago Medicine.
“We either need to accept we are going to see a bump-up in premiums—which I don’t think we want, honestly–or we have to figure out how to pay for them over time,” says Michael Sherman, chief medical officer of Harvard Pilgrim Health Care Inc.
The federal government’s Centers for Medicare and Medicaid Services hasn’t said whether it will cover the drugs, according to hospitals. The decision is left to contractors around the country that process Medicare claims, only some of which have said Medicare will pay. Hospitals have been lobbying for a reimbursement pathway.
CMS has taken steps toward developing payments to cover CAR-T and is working on more, a spokesman says, the agency proposed changes for fiscal year 2019 that hospitals say would help cover more of their costs associated with providing the new therapies.
Yuvan, from Watford, England, was diagnosed with leukemia in 2014. He received chemotherapy and then underwent a bone marrow transplant but relapsed after both treatments.Yuvan Thakkar, who has a form of leukemia, was given the personalized treatment at Great Ormond Street Hospital (GOSH), in London, after conventional cancer treatments failed.
CAR-T involves removing immune cells and modifying them in a laboratory so they can recognize cancer cells.
The CAR-T therapy, called Kymriah, the NHS has negotiated a undisclosed lower price with the manufacturer, Novartis. And the money will come from the Cancer Drugs Fund, set up to fast-track access to the most promising treatments.
Kymriah is licensed to treat patients up to 25 years old with B-cell acute lymphoblastic leukemia (ALL), for whom other treatments have failed
Source: The Wall Street Journal, OxBridge Research, BBC, Daily Stock Deals
