Highmark Inc. covers latest therapy for aggressive blood cancers

PITTSBURGH, Pa. (Nov. 6, 2018) — Chimeric antigen receptor T-cell immunotherapy, commonly referred to as CAR-T, is an emerging treatment used for advanced, aggressive forms of blood cancer. Starting this month, Highmark Inc. will cover the therapy for commercial members in Pennsylvania, West Virginia, and Delaware. The cutting-edge immunotherapy approach has been classified as an exciting advancement with some experts predicting it will change the landscape of care for those suffering from certain types of advanced leukemia and lymphoma.

As part of the medical policy, Highmark will cover Kymriah® by NOVARTIS and Yescarta by KITE Inc. First approved by the FDA in mid-2017, Kymriah is indicated for the treatment of B-cell acute lymphoblastic leukemia in patients 25 years of age or younger and for diffuse large B-cell lymphoma. Yescarta the second product approved is indicated for the treatment of diffuse large B-cell lymphoma.

"A cancer diagnosis is a life-challenging event for patients and their families, and can become an extreme financial burden. In fact, the American Society of Clinical Oncology has estimated that the cost of cancer care is expected to rise nearly 50 percent from 2010 to 2020," said Charles DeShazer, M.D., chief medical officer, Highmark Inc. "At Highmark, we strongly believe that we're a partner in our member's care — that's why we work closely with healthcare providers to offer and cover the most innovative cancer treatments for our members, right in their communities."

CAR-T immunotherapy products will be provided to Highmark members at the Allegheny Health Network Cancer Institute (AHNCI), Penn State Cancer Institute, West Virginia University Cancer Institute and the Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center (SKCCC).

"We support and enable expeditious evaluation of new and emerging therapies so that we can provide evidence-based coverage for important proven innovative treatments that optimize outcomes and value for our members," DeShazer continued.

The first step of the CAR-T treatment process involves taking blood from the patient and then isolating the T-cells, one type of the immune system's white blood cells. The extracted T-cells are then sent to a laboratory to be genetically modified or re-activated to attack cancer cells. These new "fighter" cells are frozen and sent back to the designated facility where they will be re-infused into the patient to seek out and attack the cancer.

"CAR-T is a unique 'living drug,' which can expand and persist in the body directly killing cancer cells," said John Lister, MD, Chief, Division of Hematology and Cellular Therapy, AHN Cancer Institute. "We are delighted to be able to provide our patients with access to Yescarta immediately and to Kymriah imminently. This technology will rapidly evolve and thus we look forward to participating in clinical trials to potentially improve the treatment approach and expand its indications to other forms of cancer."

To this end, The Western Pennsylvania Hospital Foundation has granted the AHN Cancer institute $1.2 million to participate in a consortium with other cell therapy experts around the world to explore creating T cells in the laboratory and testing them in clinical trials.

"AHN Cancer Institute has a long history of offering patient-centered, sophisticated care to blood cancer patients, and working collaboratively with industry, academic groups and payers. Drawing on decades of experience, we work as a team to design a specialized treatment plan for each patient, to manage side effects, and provide holistic care that addresses the needs of patients and their families," Dr. Lister said.

"At Allegheny Health Network, we're dedicated to optimizing outcomes for cancer patients and that's the driving force behind all that we do at the AHN Cancer Institute — from clinical trials to new therapies to care collaboration," said Dr. David Parda, chair of the Allegheny Health Network (AHN) Cancer Institute. "The key to making that happen is founded in the ongoing work with our partners in care including Highmark, Johns Hopkins and Penn State Health, to name a few. By working together, we'll continue to introduce new aspects to cancer care that are solely focused on a patient's health and well-being."

In April, Highmark Health donated $25 million to the Penn State Cancer Institute to fund research, recruitment and advanced therapies for its members. Highmark Health has committed $200 million to improving cancer care facilities and programs in Pennsylvania, Delaware and West Virginia.

According to the Leukemia and Lymphoma Society, there are more than 650,000 people living with or in remission from non-Hodgkin lymphoma and nearly 400,000 people living with or in remission from leukemia in the country.