Medicare AdvantageAdministrativeHigh impact
ETS exclusivity expanding to Medicare and Medicaid
Priority Health·MI · Transplant Surgery, Oncology, Hematology·Medical Policy
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
Effective October 1, 2026, Emerging Therapy Solutions (ETS) becomes Priority Health's exclusive vendor for bone marrow transplants, organ transplants, and CAR T-cell and gene therapies across all plan types, including Medicare and Medicaid (previously commercial only). Hospitals must contract with ETS by this date, or Priority Health will handle Single Case Agreements for non-contracted facilities.
Action Required
By October 1, 2026: Billing team must identify all bone marrow transplant, organ transplant, CAR T-cell, and gene therapy procedures performed at your facility. Verify that your hospital/practice has a signed contract with ETS (Emerging Therapy Solutions) that covers Medicare and Medicaid members, not just commercial members. Contact ETS at 877.445.4822 or info@emergingtherapies.com immediately to confirm contract status and expand existing agreements if needed. Update billing system to route all transplant and advanced therapy claims through ETS as the exclusive vendor for Medicare and Medicaid effective October 1, 2026. Failure to contract with ETS may result in delayed claim processing via Single Case Agreements, which could impact cash flow and member communication.