Transplant Benefits & Coverage
Blood and marrow transplant (BMT) has become a standard of care for many blood cancer and genetic diseases as well as a newer treatment option for others. For many patients, BMT represents the best or only option for a cure. Timely transplant has led to significantly improved outcomes, so patients who need a transplant also need appropriate coverage in place to ensure there are not delays to treatment. Learn about key aspects of transplant and the benefits that will support patients through the process.
- See our recommended transplant benefits featured in the NCCN and NBGH’s “An Employer’s Guide to Cancer Treatment & Prevention"
Steps in a Search for an Unrelated Donor
Only 30% of patients will have a sibling who matches and is able to donate. The other 70%, or approximately 10,000 people per year, need an unrelated donor to donate their healthy marrow or to use a previously donated umbilical cord blood unit. The Be The Match Registry® can be searched for those patients who do not have a related donor. The search process includes:
- Preliminary Search: When a patient requires a transplant from an unrelated donor, a physician can request a free preliminary search of our Be The Match Registry to determine if there are potential matches. This search returns a snapshot of potential matched unrelated donors and umbilical cord blood units (CBUs).
- Formal Search: To verify that potential donors or cord blood units match the patient, transplant center physicians in our network can initiate a formal search to request further testing of potential donors or CBUs listed on our registry. A formal search includes a one-time activation fee plus additional costs for outreach and lab tests of potential donors and/or CBUs.
- Donor Management and HLA Typing: Our donor centers contact potential donors, set up appointments, and perform high-resolution HLA testing, health history screening, infectious disease testing and collect samples for use by transplant centers. Costs vary because of the number of donors that need to be tested to find an actual match.
- Cell Procurement/Infusion: The cost of procuring unrelated donor cells varies greatly depending on the cell type and transplant protocol. These costs may be as low as $30,000 or higher than $60,000 in cases where a patient requires two simultaneous infusions of cells, such as a double cord blood transplant.
Costs also vary based on the location of the donor or cord blood unit that is the best match for the patient. We work with a number of registries across the world to have access to international donors. Each registry sets its own price for donor products. Cord blood unit prices vary by cord blood bank, as each sets its own fees.
Key Benefits for Supporting the Transplant Process:
There are several components to transplant that require specialized benefit support. Providing these benefits will greatly assist in achieving the best possible outcome for the patient.
- Donor Search and Cell Acquisition: The process for identifying a donor and acquiring the cells used for BMT is substantially different than the process used in solid organ transplantation. Patients need full coverage for HLA typing of themselves, their potential related donors and the potential donors on the Be The Match registry. They also need coverage for the cell source that is identified based on their particular clinical situation—marrow, PBSC or cord blood.
- Inpatient Stays and Clinic Visits: Patients receiving an unrelated donor transplant may stay in the hospital up to 100 days after cell infusion. They will also need a number of follow-up clinic visits and many of these may need to be at the hospital where they received their transplant, due to the specialization and training of the clinical teams.
- Medications: Access to medications is critical for success of BMT. Prohibitive co-payments or co-insurance on medications may result in non-compliance, poor outcomes, graft failure and/or expensive hospital readmissions due to infection or complications.
- Clinical Trials: The remarkable improvement in outcomes of HCT has been made possible because of clinical trials. Many patients who receive an HCT will be asked to join a clinical trial. The trials used in HCT do not mean that the medication or treatment is unproven or never before tested. Often the trial will test two standard options to determine which yield better results. Results of clinical trials improve care for all patients. Identical care outside of a trial has identical cost without gaining future benefit from trial outcomes.
- Travel/Lodging: Patients may need to travel during the transplant process for a variety of reasons—access to an in-network transplant center, access to a center that specializes in their disease condition, and/or follow-up care post-transplant with their original treatment team. The typical travel and lodging allows for up to $10,000 in travel related costs and follows IRS specifications in how the benefit can be provided.