Drugs, Diseases and the Managed Care Impact
Contact Hours: 1.5 | Activity Type: Knowledge-based | ACPE UAN: 0233-0000-18-055-L04-P
The CAR-T treatment process is complex and involves a multidisciplinary team, with intense coordination between patients, treating providers, manufacturers and payers. Clinicians are tasked with coordinating the treatment of oncology patients with autologous T cell immunotherapy. In an insurance landscape where patients often switch health care coverage, payers and stakeholders are tasked with assuring appropriate provider reimbursement of a one-time, inpatient-administered therapy across the medical and pharmacy benefit.
This session will take learners through the CAR-T treatment process and identify its impact on patient outcomes through a review of supporting clinical evidence. Learners will identify payment strategies of commercial, Medicare and Medicaid payers, as well as manufacturers. Finally, learners will review an example of how one Medicaid program carved out CAR-T immunotherapies from the medical benefit to ensure appropriate provider reimbursement, and the lessons learned in the creation of a monitoring program.
At the completion of this activity, participants should be able to: