Closing the Cell Therapy Reimbursement Gap: Christine Pfaff, RPh, MBA

Community oncology practices face significant financial strain from the extended monitoring required after cellular therapy infusion, underscoring the need for new reimbursement pathways and stronger payer partnerships, Christine Pfaff, RPh, MBA, director of clinical initiatives at the Community Oncology Alliance (COA), told The American Journal of Managed Care^®.

In the second part of her interview at the 2026 COA Payer Exchange & Innovation Summit, she discussed the operational costs of posttreatment monitoring, emerging carve-out payment models, and the importance of proactive payer engagement.

Pfaff explained that patients receiving cellular therapy require close monitoring for 30, 60, 90 days, or longer after infusion, requiring help from a multidisciplinary team. Currently, practices receive no reimbursement for that monitoring period. Although tools such as remote therapeutic monitoring exist, reimbursement for postinfusion care remains minimal, she said, making it difficult for practices to sustainably staff the teams these therapies require.

Pfaff pointed to ongoing discussions about establishing a dedicated Current Procedural Terminology code to cover monitoring for advanced therapies, including bispecific antibodies and chimeric antigen receptor T-cell treatments. She acknowledged that creating and gaining recognition for such a code will not happen quickly but said the goal is to reach a point where that work is both recognized and reimbursed.

She also highlighted carve-out program models discussed during an earlier session at the meeting, in which organizations pay providers upfront rather than requiring practices to front the cost of expensive cellular products, with some models also covering nursing care. These arrangements acknowledge the added costs practices absorb and can still deliver a lower total cost of care than academic centers. Pfaff said she believes this argument should encourage payers to direct more patients toward community-based programs.

On payer relationships, Pfaff emphasized the value of early, proactive conversations, noting that many payers remain unaware that community practices are both willing and able to deliver cellular therapy. She said she would like to invite payers directly into practices to observe patient monitoring and outcomes firsthand. Still, Pfaff acknowledged that limited data on community-based outcomes currently make that case harder to build.

She tied the reimbursement conversation back to broader access concerns. Without solving payment challenges, she said, practices cannot grow their programs, and patients lose access to rapidly advancing therapies that are moving into earlier treatment lines and expanding into autoimmune disease.

"I think if we really want patients in the US to have access to this great care, we have to figure out a way that we can deliver it where they're living, close to home, high quality, and low cost," Pfaff concluded. "It all comes together. It's just that we haven't told the story yet."