Benefit Design for HCT

Benefit Design for HCT: Brief Summary

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. While finding a clinical trials program can be challenging, NMDP has a tool through the Jason Carter Clinical Trials Program that searches for trials and provides a summary of that trial in simple to understand language.
• 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. 

For additional rationale and administrative guidance regarding these key benefits, download our Benefit Design for HCT document.

See our recommended transplant benefits featured in the NCCN and NBGH’s “An Employer’s Guide to Cancer Treatment & Prevention"