For many patients battling life-threatening blood cancers -- such as leukemia and lymphoma -- and other blood disorders, a marrow or umbilical cord blood transplant is their only hope for a cure. In 1980, Congress made a commitment to these patients by establishing a national marrow registry through the C.W. Bill Young Cell Transplantation Program, allowing patients and their doctors to seek matches for a marrow transplant. Today, this registry is the largest and most diverse registry in the world.
The National Marrow Donor Program (NMDP)/Be The Match -- the organization entrusted to operate the national Be The Match Registry -- has worked tirelessly during the last 30 years to increase the number of marrow donors and cord blood units available, which has grown to include more than 13.6 million adult volunteer marrow donors and 225,000 cord blood units donated by mothers after child birth.
Additionally, international relationships increase access to adult donors and cord blood units -- there is a total of 24.5 million potential marrow donors and 609,000 cord blood units worldwide. While the registry has millions of potential donors, some patients still struggle to find a donor match, or worse yet cannot access transplant when a match is available, both signaling that there is much work to be done to increase access to this life-saving treatment.
One such barrier is the lack of coverage options for many American seniors, who are unable to afford or access transplant because of out-of-pocket costs and outdated Medicare reimbursement policies.
The Centers for Medicare & Medicaid Services (CMS) has created financial obstacles for potential Medicare marrow recipients by creating uncertainty around whether a transplant will be covered. Of the more than 70 conditions and diseases that private insurers cover, Medicare currently only covers a handful. If Medicare does not cover the transplant, the beneficiary becomes responsible for the full cost of the procedure. This means that a patient who is 64-years-old may no longer have access to life-saving transplants once they turn 65 years old and are enrolled in Medicare.
This alone illustrates that while medical science has improved, federal coverage and payment have failed to keep pace. The U.S. Department of Health and Human Services estimates that nearly 20,000 people in the U.S. could benefit from a life-saving marrow or cord blood transplant each year, yet federal Medicare policy fails to ensure access for all clinically eligible Medicare patients.
As baby boomers continue to age and enter the Medicare program, this problem is only expected to worsen. In fact, current Medicare beneficiaries make up nearly 16 percent of the stem cell transplants facilitated by the NMDP/Be The Match. In some diseases, such as acute myeloid leukemia, the median age of diagnosis for AML is 67-years-old according to the American Cancer Society -- solidly within the Medicare population's demographic. Simply put, Medicare beneficiaries should be allowed the same access to potentially curative options as those under the age of 65.
While CMS has worked with the bone marrow transplant community in the past to expand coverage, changing these rules is a slow process and contractors more often than not refuse to reimburse transplants for indications that CMS does not expressly cover.
For those indications that are covered under Medicare, the reimbursement rates fall short of covering the cost of providing services primarily because the rates do not recognize the costs of search and procurement. The federally approved search and procurement cost is actually higher than the entire inpatient hospital rate for transplants, and more than 15 times higher than the outpatient hospital rate.
CMS should recognize there are patients desperately needing marrow transplants now who can't wait any longer for Medicare to slowly update the rules -- their lives are in jeopardy today.
No one should be denied access to the care they need due to their age, and it's time for CMS to update reimbursement policies to ensure all in need of marrow transplant are guaranteed access to these life-saving procedures.
Fred LeMaistre, MD, leads the development of the Sarah Cannon Blood Cancer Network, which provides a multidisciplinary approach to standardize blood cancer therapies including blood and marrow transplantation. He is a founding member and former president of the Foundation for the Accreditation of Cellular Therapy, is board certified in internal medicine and medical oncology, and has published more than 200 manuscripts.