Medicare Expands Stem Cell Transplant Coverage for Myelodysplastic Syndromes

The Centers for Medicare & Medicaid Services (CMS) have broadened its coverage for allogeneic hematopoietic stem cell transplantation (HSCT) in treating individuals with myelodysplastic syndromes (MDS), responding to a joint reconsideration request from major medical organizations. This notable policy revision promises to increase treatment accessibility for Medicare beneficiaries battling this group of blood disorders that impede the bone marrow's capacity to generate functioning blood cells.

Effective as of March 22, 2024, this adjustment in the National Coverage Determination (NCD) was advocated by The American Society of Hematology (ASH), the American Society for Transplantation and Cellular Therapy® (ASTCT®), the National Marrow Donor Program (NMDP), and the Center for International Blood and Marrow Transplant Research (CIBMTR). It highlights Medicare's commitment to supporting treatments like allogeneic HSCT, the only curative measure currently available for MDS, which primarily affects older adults.

The updated policy specifically extends full Medicare coverage for stem cell transplantation procedures using bone marrow, peripheral blood, or umbilical cord blood, removing the former Coverage with Evidence Development (CED) requirement. This change acknowledges the critical role of insurance coverage in facilitating patient access to HSCT, as evidenced by a significant increase in transplantations among older patients since the introduction of CED in 2010.

Leaders within the ASTCT have expressed their encouragement over the revised NCD but highlighted the ongoing need to address treatment and coverage obstacles that patients face. This policy update represents a significant step towards ensuring more patients have the opportunity to receive potentially life-saving stem cell transplants.