Advanced Therapy Programs
The payer knows more about your contracts than you do. We change that.
HealthPulse brings direct provider-side reimbursement experience, built from negotiating against payers on CAR-T, TIL, transplant, and rare-oncology contracts, to programs navigating one of the most complex reimbursement environments in modern medicine. That vantage point is built directly into the firm's methodology.
FY2027 CAR-T Per-Case Economics: Key Findings
FY2027 illustrative national IPPS base payment for MS-DRG 018, effective October 1, 2026
CMS FY2027 final-rule Tables 1B, 1D and 5; +6.1% versus FY2026
$333,445
FY2027 IPPS fixed-loss amount, effective October 1, 2026
+22.2% versus FY2026
$49,346
Average Drug Acquisition Cost
Manufacturer WAC data, all 7 FDA-approved products
$530K
Total Cost of Care, Academic Programs (Median)
Di et al., JNCI Cancer Spectrum, Aug 2024
$608,100
Effective Clinical Trial Payment (FY2026)
Adjustment factor cut from 0.33 to 0.16. FY2026 historical value; FY2027 treatment requires separate analysis.
$50,277
Published per-case loss after outlier payments
Penn/JCO 2020; Avalere Health 2025
$63K–$304K
Illustrative national operating-plus-capital base payment for MS-DRG 018, calculated using the FY2027 final MS-DRG relative weight of 45.1272, national operating standardized amount of $6,848.98, capital federal rate of $540.03, and assumed wage index and capital geographic adjustment factor of 1.000. Assumes submission of quality data and meaningful EHR use. Excludes hospital-specific wage and geographic adjustments, IME, DSH and uncompensated-care payments, NTAPs, transfer adjustments, quality-program adjustments, and outlier payments.
Example mechanisms HealthPulse may test for, where relevant: single-case-agreement deficiencies prior to first infusion, outlier-payment gaps, and Revenue Code 891 billing opportunities. Not asserted as present in any specific program.
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