Patient Access & Insurance Coverage

Coverage and reimbursement for Bristol Myers Squibb CAR T cell therapies may vary based on payer-specific requirements, potential site/setting of care, and patient-specific benefits.

Benefit verification (BV) with a patient’s payer is critical to help identify specific considerations for each appropriate candidate for Bristol Myers Squibb CAR T cell therapies. Our Insurance Coverage Lookup tool can provide information to assist in the BV process, or Cell Therapy 360^® can provide BV assistance to verify patient-specific coverage requirements.

Download the CAR T BV checklist for a helpful guide on the type of information that needs to be confirmed during the BV process for CAR T cell therapies.

KEY FACT

Treatment centers should confirm access prior to apheresis scheduling, including BV, prior authorization (PA) approval, and single case agreement (if required).

For questions, please contact your Bristol Myers Squibb Account Representative or call Cell Therapy 360 at 1-888-805-4555.

Bristol Myers Squibb is committed to delivering optimal patient and customer experience with cellular therapies. This information will help appropriate patients get access to our CAR T cell therapies and help treatment centers navigate the reimbursement process.

_{This information is provided for educational purposes only. Bristol Myers Squibb cannot guarantee insurance coverage or reimbursement. Coverage and reimbursement may vary significantly by payer, plan, patient, and setting of care and is subject to frequent change. It is the sole responsibility of the healthcare provider to select the proper codes and ensure the accuracy of all statements used in seeking coverage and reimbursement for an individual patient.}

For more information on coverage for CAR T cell therapies, please click each payer type below.

Medicare Fee-for-Service (FFS) Patients

Medicare Advantage (MA) Patients

Commercial Patients

CAR T CELL THERAPY RESOURCES

CAR T Benefit Verification checklist

Template letter of intent

Template letter of medical necessity

Template letter of appeal

National Coverage Determination flashcard

PRODUCT-SPECIFIC INFORMATION AND CODES

Lisocabtagene maraleucel

For the treatment of:

R/R large B-cell lymphoma (R/R LBCL)
R/R follicular lymphoma (R/R FL)

Idecabtagene vicleucel

For the treatment of:

R/R multiple myeloma (R/R MM)

_{CAR=chimeric antigen receptor; R/R=relapsed or refractory.}

References

Centers for Medicare & Medicaid Services. Decision memo for chimeric antigen receptor (CAR) T-cell therapy for cancers. Accessed October 20, 2023. https://www.cms.gov/medicarecoverage-database/details/nca-decision-memo.aspx?NCAId=291
Medicare costs. Accessed October 20, 2023. https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
Centers for Medicare & Medicaid Services Medicare Learning Network. Billing instructions for beneficiaries enrolled in Medicare Advantage (MA) plans for services covered by Decision Memo CAG-00451N. Published October 24, 2019. Accessed October 20, 2023. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE19024.pdf
Centers for Medicare & Medicaid Services. Medicare Managed Care Manual, Chapter 4. Accessed October 20, 2023. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c04.pdf
Kaiser Family Foundation. Medicare Advantage in 2023: premiums, out-of-pocket limits, cost sharing, supplemental benefits, prior authorization, and star ratings. Published August 9, 2023. Accessed October 6, 2023. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-premiums-out-of-pocket-limits-cost-sharing-supplemental-benefits-prior-authorization-and-star-ratings
Kaiser Family Foundation. Employer health benefits. 2023 annual survey. Published October 2023. Accessed October 20, 2023. https://www.kff.org/health-costs/report/2023-employer-health-benefits-survey/