Current CAR-T Therapy Trends in Managed Care | AMCP Annual 2025

The growing popularity of expensive CAR-T therapies means that managed care leaders must adapt to make the therapies more accessible and affordable, according to Marnie W. Bute, RN, managing director of Aon, and Brenda Cordell, MBA, a senior healthcare consultant who specializes in cell and gene therapy. The session was moderated by Chad Barker, a colleague of Cordell's at Milliman.

Marnie W. Bute, RN

There are currently 10 CAR-T therapies across eight different cancer indications with list prices ranging from approximately $450,000 up to $530,000, Cordell told the AMCP audience at the afternoon education session.

Brenda Cordell, MBA

The therapy must be administered at designated treatment centers, which patients often must stay near for approximately four weeks per treatment.

The high cost is driven by risks associated with purchasing, managing and storing the drugs, Cordell explained. Because these therapies are often one of the last resorts for patients, treatment adherence is high. However, because some patients are so ill, there isn’t a guarantee they will finish the treatment. The therapy regimen is lengthy, consisting of five parts.

Patient cells are collected, which takes about a day. Those cells are then taken and genetically modified and reinjected back into the patient in a low dose, which takes several days. Then comes the full infusion, followed by a short-term monitoring period where the patient is monitored for side effects, such as cytokine release syndrome (CRS). That period is followed by a long-term, continued assessment where the therapy is examined for effectiveness.

Bute and Cordell shared several notions about how the cost and complexity of CAR-T might be tamed. They suggested grouping CAR-T treatment in centers of excellence that specialize in CAR-T and provide the follow-up monitoring. There are currently 341 centers in the United States, but they all have varying levels of expertise when it comes to CAR-T therapies, Bute and Cordell explained.

Reimbursement uncertainty is another significant challenge, they noted. “When working with payers, the thing that we hear is lack of information from manufacturers,” Cordell said. “I think the way that manufacturers can best work with payers is in terms of expectations.”