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Policy Category: Reimbursement

PMC advises Medicare and Medicaid officials on reimbursement policies that can help ensure sustainable patient access to personalized medicine. In 2020, for example, PMC began advocating for increased Medicare payment rates for hospitals that provide chimeric antigen receptor T-cell therapies, a potentially life-saving class of personalized cancer treatments. PMC’s recommended payment solution is still in place today.

Encouraging the Continued Development of Personalized Treatments Under the Inflation Reduction Act: PMC Letters of Support for the EPIC, ORPHAN Cures, and MINI Acts

Concerns About AHRQ Review Protocol for Blood-Based Tests for Multiple Cancer Screening

Reducing Administrative Barriers to Accessing Personalized Medicine: Utilization Management Policies in the Medicare Advantage Program

Request for Reconsideration of UnitedHealthcare’s Revised Pharmacogenetic Testing Policy

Reducing Diagnostic Testing Coverage Barriers for Medicaid Patients With Suspected Rare Diseases

Legislation to Enable Medicare Reimbursement for Genetic Counselors

2025 Payment Policies at the Centers for Medicare & Medicaid Services

Inflation Reduction Act/Medicare Drug Price Negotiation Program

Medicare Payments for Chimeric Antigen Receptor T-Cell Therapies

Medicaid Rebates for Cell and Gene Therapies: Comment Letter About Proposed Changes to the Medicaid Drug Rebate Program

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