In an unexpected move, the U.S. Department of Health and Human Services will allow Novartis (NVS) to pay for travel, lodging, and meal expenses for Medicare and Medicaid beneficiaries who must leave home to be administered the Kymriah gene therapy.
The HHS OIG issued a so-called advisory opinion in response to a request from the drug maker, which wanted to avoid sanctions that would normally be levied against a pharmaceutical company that sought to reimburse Medicare and Medicaid patients. Under federal law, such payments would be considered the equivalent of a kickback.
In seeking its request, Novartis maintained low-income patients who lived far from treatment centers need financial assistance, without which the medication would literally be out of reach. And the HHS Office of Inspector General agreed, but to be eligible, patients must live two hours’ driving distance or 100 miles from the nearest center and not have insurance for non-emergency medical travel.
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