Treatment Coverage and Reimbursement

Cornelie Haag

doi:10.1007/978-3-030-94353-0_45

Abstract

AbstractThe conditions for reimbursement for CAR-T cell therapy are not uniform in Europe. Most European countries use a DRG system for billing hospital services, but the details vary. Nonetheless, the similarity is that expensive therapies, such as CAR-T cell therapy, are initially not included in the DRG system. Most countries possess instruments to ensure the financing of such expensive therapies outside the DRG system as separate payments. These reimbursement instruments of DRG systems are used in most countries both for short-term financing for innovative and new therapies and as long-term additional fees within the respective DRG system. Individual countries maintain different regulations, and therefore, hospitals have the responsibility to determine the specific requirements of their country before establishing CAR-T cell therapy.

Highlights

The conditions for reimbursement for CAR-T cell therapy are not uniform in Europe
Individual countries maintain different regulations, and hospitals have the responsibility to determine the specific requirements of their country before establishing CAR-T cell therapy
One should consider that other significant costs exist in addition to the price of the actual CAR-T cell product, which has been agreed upon with the pharmaceutical industry

Summary

Introduction

The conditions for reimbursement for CAR-T cell therapy are not uniform in Europe. The similarity is that expensive therapies, such as CAR-T cell therapy, are initially not included in the DRG system. Most countries possess instruments to ensure the financing of such expensive therapies outside the DRG system as separate payments. These reimbursement instruments of DRG systems are used in most countries both for short-term financing for innovative and new therapies and as long-term additional fees within the respective DRG system.

Results

Conclusion