New Models for Cellular Therapy Delivery: Christine Pfaff, RPh, MBA

Community oncology practices face reimbursement, cost, and operational barriers to delivering cellular therapy, highlighting the need for new business models and collaboration with payers, Christine Pfaff, RPh, MBA, told The American Journal of Managed Care^® at the 2026 Community Oncology Alliance (COA) Payer Exchange & Innovation Summit.

Pfaff, director of clinical initiatives at COA, moderated the “Transformative Business Models for Delivering Cellular Therapy" session on September 15. She and a panel of experts reviewed the results of the COA Cellular Therapy Survey, including findings related to access. They also examined business models designed to make cellular therapy delivery feasible in community oncology and highlighted carve-out arrangements and other partnership approaches that address financing and reimbursement.

Pfaff explained that the COA Cellular Therapy Survey was designed to gauge where oncology practices currently stand in delivering cell-based treatments, identify the barriers they face, and explore how manufacturers and other stakeholders can better support them. It aimed to establish a baseline understanding of which practices are planning to launch cellular therapy programs, which already have programs underway, and what the field might look like over the next 3 to 5 years.

Reimbursement and total product cost emerged as the top concerns among survey respondents regarding their ability to start a program, Pfaff noted. Unlike traditional chemotherapy or bispecific therapies, which are administered on a weekly or biweekly basis, cellular therapy is typically a single dose that can cost around $500,000, raising concerns among practices that they may not be adequately reimbursed.

Pfaff also pointed to the operational challenges of coordinating with hospital partners to manage acute adverse events, since practices need access to ICU beds, tocilizumab, neurology, and infectious disease support when complications arise. These types of collaborations remain relatively new territory for many community practices, she said.

She then addressed the broader shift in how cellular therapy is delivered, noting that when cellular therapy first became commercially available in 2017, it was typically administered within hospital-based transplant networks under a bundled diagnosis-related group reimbursement model tied to an inpatient stay.

Today, care is increasingly moving into community settings. For example, a patient may undergo apheresis at a freestanding center, receive lymphodepleting chemotherapy in clinic, return for chimeric antigen receptor T-cell infusion, and then continue follow-up care. This workflow does not align with the traditional transplant-center model.

Because of this shift, Pfaff emphasized the need for continued collaboration with payers to help them recognize that this community-based delivery approach, while structurally different, can still provide high-quality, more accessible care for patients.

“How do we move together with the payers so that they recognize what we're delivering in the community as being different but still very good for patients and also more accessible?” she concluded.