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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.

CMS’ Proposed Changes to ‘Laboratory Date of Service Policy’

CMS’ Oncology Care Model

CMS’ Coverage of Next-Generation Sequencing-Based Diagnostic Tests

CMS’ Proposal to Implement Step Therapy for Part B Drugs Covered by Medicare Advantage Plans

CMS’ Request for Information on New Directions for the CMS Innovation Center

CMS’ Molecular Diagnostics Gapfill Payment Amounts

CMS’ Implementation of the Protecting Access to Medicare Act of 2014

CMS’ Request for Information on Specialty Practitioner Payment Models

Frameworks for Reimbursement of Diagnostics in Europe and the United States

CMS’ Guidance on Coverage and Evidence Development

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