In a monumental shift, the Centers for Medicare & Medicaid Services (CMS) have expanded Medicare coverage for allogeneic hematopoietic stem cell transplants (HCT) for eligible patients over 65 suffering from myelodysplastic syndromes (MDS). This landmark decision is the culmination of decades of research led by the Medical College of Wisconsin (MCW) Cancer Center, in collaboration with the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) and key advocacy groups including the American Society of Hematology (ASH), the American Society for Transplantation and Cellular Therapy (ASTCT), and the National Marrow Donor Program (NMDP).
The Battle Against MDS
Myelodysplastic syndromes are a group of cancers that impair the body’s ability to produce healthy blood cells. For patients with MDS, allogeneic HCT stands as the only curative therapy. Until now, Medicare did not cover this vital treatment for patients 65 and older, largely due to a lack of clinical evidence supporting the benefits of transplantation for older adults. This gap in coverage left many older patients without access to potentially life-saving transplants.
Dr. Douglas Rizzo, Senior Scientific Director of the Center for International Blood and Marrow Transplant Research (CIBMTR) and Cancer Service Line Director at Froedtert & the Medical College of Wisconsin, highlighted the previous challenges. “Older adults were overlooked as candidates for transplant because they did not have Medicare coverage for the procedure,” Dr. Rizzo explained. “We used our expertise in transplantation and the CIBMTR and BMT CTN research platforms to develop trials that provided the necessary evidence to inform Medicare payment policy.”
Pioneering Research and Transformative Outcomes
By enrolling Medicare beneficiaries in observational and interventional trials, researchers were able to demonstrate the effectiveness and safety of HCT for older patients. This led to a significant policy change, allowing thousands of older Americans with MDS to receive life-saving transplants. “In the first three years after Medicare agreed to provide coverage conditional on participating in approved studies, the number of transplants more than quadrupled,” noted Dr. Rizzo. “We started to see lifesaving outcomes that proved our belief that older patients would benefit from transplantation, just the same as younger patients.”
The impact of this research is profound. Since the initial policy change, nearly 6,000 Americans over 65 have received allogeneic HCT. Studies presented at ASH meetings and published in the Journal of Clinical Oncology revealed that these patients experienced a significant survival advantage and improved quality of life compared to those who did not receive the transplant.
Collaborative Efforts and Advocacy
This groundbreaking change was made possible through the collaborative efforts of MCW, NMDP, ASH, and ASTCT. The recent National Coverage Analysis Decision Memo by CMS deems the treatment “reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act.” This decision ensures that more seniors will have access to the life-saving treatment they need.
“We are proud to be part of this important work to bring greater HCT access to people on Medicare with MDS,” said Mohandas Narla, ASH President and distinguished scientist at New York Blood Health Enterprises. “This would not have been possible without the dedicated research and collaboration from Dr. Rizzo, CIBMTR, and our other partners. We will continue to work together to expand access and improve care and outcomes for people on Medicare.”
Looking Ahead
The expanded Medicare coverage is a significant step forward in providing equitable healthcare access to all patients, regardless of age. The Medical College of Wisconsin Cancer Center and its partners remain committed to advancing research and improving the lives of those affected by MDS. With ongoing studies and continuous advocacy, they aim to ensure that every patient has the opportunity to benefit from the best possible care.
For more information about the expanded coverage and the impact of this decision, visit the Medical College of Wisconsin Cancer Center website.
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