CAR-T Reimbursement In The US: ZS Separates Myths From Reality

By Meghan McDonald, Bernadette Bourjolly, Shanaya Shah

There has been much discussion and debate around whether the reimbursement rates treatment centers receive for administering CAR-T cell therapies are adequate. On paper, it appears that reimbursement is less than the cost of the drug itself, and that it fails to cover the additional costs required to safely prepare and monitor patients before and after administration. Many stakeholders have understandably assumed that for some treatment centers, inadequate CAR-T reimbursement may be too much to bear, resulting in fewer patients having access to these potentially lifesaving therapies. But is this indeed the case?

Five years and six CAR-T approvals later, we set out to explore three common assumptions that we suspected could be myths. Specifically, we wanted to understand the extent to which reimbursement and financial dynamics are directly shaping the CAR-T treatment landscape today, and implications as we look to the future. To do this, we surveyed pharmacy and medical directors at CAR-T treatment centers across the U.S. by leveraging ZS’s PayerLive, an online primary research platform. We also had in-depth discussions with payers and treatment centers to understand CAR-T reimbursement realities.

Continue for the full discussion on how manufacturers and treatment centers can work together to improve the financial viability of CAR-Ts, so even more patients will benefit in the short and long term.