Be The Match Works to Obtain Medicare Coverage for Bone Marrow and Cord Blood Transplants

Posted January 15th, 2016 by Be The Match and filed in News
Show Content

Marrow and cord blood transplants can be used to successfully treat more than 70 diseases. Often transplant is a patient’s only hope for a cure. While commercial insurance covers transplant for most, if not all, diseases, the Medicare program does not. This means that if someone develops a disease or condition when 65 or older, or on long-term or permanent disability, he or she may not have access to a life-saving transplant.

Be The Match, in partnership with the American Society for Blood and Marrow Transplant (ASBMT), is working closely with the Centers for Medicare and Medicaid Services (CMS) to provide Medicare beneficiaries with access to a life-saving transplant for more diseases. Currently, Medicare only covers transplants for the following diseases:

  • Leukemia, leukemia in remission or aplastic anemia when it is reasonable and necessary
  • Severe combined immunodeficiency disease (SCID) and Wiskott-Aldrich syndrome
  • Myelodysplastic Syndromes (MDS), if it meets criteria for Coverage with Evidence Determination (CED), which requires data collection of a Medicare-approved, prospective clinical study.

We have made important progress to expand this coverage in recent months. As a result of our efforts, CMS is considering coverage for three new diseases:

  • Sickle Cell Disease
  • Myelofibrosis
  • Multiple Myeloma

Similar to MDS, coverage for these diseases may also require a Medicare-approved, prospective clinical trial. This is called CED. CED would allow individuals with sickle cell disease, myelofibrosis and multiple myeloma to receive a transplant while CMS gathers data on the outcome of transplant for these diseases. Once enough data is gathered to show transplant effectively treats these diseases, CMS may establish a National Coverage Determination (NCD). This means Medicare would now cover transplant for these three diseases without requiring enrollment in a clinical trial.

CMS is currently considering how to design a study for these three diseases. Be The Match and ASBMT are working closely with CMS to make sure the study requirements do not create unnecessary barriers for patients.

Establishing clear coverage rules is important to protect access to life-saving transplants. Medicare is silent on whether it will cover marrow or cord blood transplant for all other diseases that are not specifically listed as covered. Because Medicare will not tell hospitals upfront if it will cover transplants for most diseases, hospitals may not be able to move forward with the transplant due to the uncertainty. This creates a barrier for patients who need a marrow transplant to cure their disease.

Be The Match and ASBMT will continue efforts to expand access to transplant for the Medicare population. We will need your help as well, so please stay tuned for further developments.

5 Responses to “Be The Match Works to Obtain Medicare Coverage for Bone Marrow and Cord Blood Transplants”

  1. Rosemary Graham-Gardner says:

    I firmly believe that all Americans have the right to proper healthcare and especially the elder who have worked and fought hard to make this country what it is. This country is an insult in comparison with the rest of the World.

    • Rachel Lewis says:

      With all due respect but a little bit of anger at your uninformed condemnation, the diseases they are talking about getting Medicare coverage for here are diseases that the medical experts are just figuring out how to treat with BMT and CBT, and a huge number of the experimental subjects to date have been children. Don’t complain because a bunch of gravely ill children were subjected to experimentation in this area first. Be grateful that Medicare beneficiaries are soon going to gain from the lessons that have been learned on the backs of those extraordinarily brave children.

  2. Rachel Lewis says:

    Let me know if I can help with this somehow. I coded insurance claims for BMT and CBT for a few years and know at a layperson level how grueling but effective it is. Of the 3 diseases CMS is looking at approving for Medicare coverage, I had most coding experience with sickle cell patients. I’m thrilled to hear that the research continues to advance!

  3. As the wife of a 67 year old husband with AML, I am so grateful for all the effort made by Be The Match. So many lives of all ages have been saved, and ALL lives are important!
    I hope there will be some way that I can help and give back in the future.
    Thank you
    Sandra Burnette

  4. Milton says:

    My partner and I are both all sinegd up and have made it clear to both our families that we wish to donate. When we sinegd up I had trouble registering the children but will take another look at how to do that today – regardless – our families are well aware that in the event of an accident where we could not make a decision we’d like the children’s organs to be donated too.

Leave a Reply