Insurance Delays Add Costs to CAR T-Cell Therapy: Ravi Vij, MD, MBA

Access to chimeric antigen receptor (CAR) T-cell therapy in blood cancers can be slowed by insurance approvals, creating challenges for patients with aggressive disease.

In an interview with The American Journal of Managed Care^®, Ravi Vij, MD, MBA, professor of medicine in the Division of Medical Oncology at Washington University School of Medicine, described how commercial payer processes like benefit verification and single-patient agreements contribute to longer wait times compared with Medicare. According to him, these delays not only postpone potentially life-saving treatment but can also drive up costs as patients often require expensive interim therapies to control disease progression.

Vij emphasized that operational improvements, including case rate–based reimbursement and off-the-shelf technologies, may help shorten the timeline from diagnosis to treatment.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Delays in blood cancer testing and diagnosis can slow down treatment. Which patients are most impacted by these delays?

Getting CAR T does involve delays with insurance, and these delays are more marked when commercial insurance is something that has to be dealt with. With Medicare, at the moment, as long as you meet Medicare guidelines you are able to fast track the approval process, whereas with commercial payers it's a multistage process of first benefit verification, then looking at a set of data for them to establish eligibility. And then most of these are, at the moment for commercial payers, single-patient agreements that add further to the delays in this process. There are very few that are going to case rate–based delivery at the moment.

How do these delays contribute to increased costs of care?

Delays add to the cost because a lot of these patients have diseases that are aggressive and require interim therapy to keep their disease in check, often for several months by the time the infusion of the CAR T occurs, and these therapies themselves can be expensive. In the case of myeloma, we often use bispecifics to bridge—that is in itself an expensive modality of therapy. Also, as more patients wait longer, they are more likely to have side effects from their treatments requiring hospitalization, and that adds to the costs as well.

What operational changes could help patients get started on treatment sooner?

I think obviously new technologies that allow for ready, off-the-shelf availability of products is very important. Cutting down the what we call the vein-to-vein time is important, but also the brain-to-vein time, which is the time from which you first see the patient to the delivery of the CAR T into the patient, and that is often a result of insurance delays, as we said. What could help there is shifting to a case rate–based mechanism whereby unnecessary delays for single patient agreements are not encountered.