Government quit test of pricey cancer treatment amid concerns over industry role

Medicare and Medicaid administrators earlier this year ended a plan to pay for a breakthrough, half-million-dollar cancer treatment based on how well it worked. The payment deal for Swiss drug giant Novartis' tisagenlecleucel (Kymriah) therapy received internal HHS scrutiny and is the target of current congressional investigations.

Medicare and Medicaid administrators earlier this year ended a plan to pay for a breakthrough, half-million-dollar cancer treatment based on how well it worked. The payment deal for Swiss drug giant Novartis' tisagenlecleucel (Kymriah) therapy received internal HHS scrutiny and is the target of current congressional investigations. CMS touted how the "pay-for-performance" arrangement would save lives and cut Medicare and Medicaid spending right after FDA approved the company’s $475,000 gene therapy to treat kids and young adults with leukemia. Just 7 months later, CMS pulled out, reportedly because of administration lawyers' concern over how much Novartis itself was influencing the arrangement, including giving advice on the payment criteria for tisagenlecleucel. The deliberations over Kymriah took place before current HHS Secretary Alex Azar was confirmed.