Reimbursement and Geography as Barriers to CAR-T Access

This episode, "Reimbursement and Geography as Barriers to CAR-T Access," features the panel examining why proximity to care is only half the battle.

Dr. Graff explains that many community sites within networks like the Exigent Research Network already run fully functional bispecific antibody and clinical trial programs, carrying the same CRS and neurotoxicity risks CAR-T presents. Even so, FACT accreditation often determines whether those sites can actually deliver CAR-T, because unlike large academic institutions, physician-owned community practices depend directly on reimbursement to keep their doors open. When a practice cannot get reimbursed, or cannot stock certain medications, patients who live nearby suddenly face two, four, or six-hour drives depending on where they live. Geography becomes a major logistical and financial threat to practices trying to keep care close to home.

Dr. Patt describes T-cell engaging therapy as a multidisciplinary undertaking that requires tight coordination between community practices, hospital systems, and multiple team members. She expects this coordination to grow easier as clinicians gain more experience managing toxicities and as newer, less toxic agents become available, even off the shelf. Today, though, she identifies reimbursement as the major limitation diminishing community oncology access. Outpatient administration costs roughly a third of the hospital setting, she notes, yet payers remain reluctant to contract in a way that keeps practices financially whole.

For an independent, physician-owned private practice, she explains, taking on the risk and the millions of dollars in debt required to stand up this therapy is often too great a leap. That financial exposure, more than clinical readiness, is what keeps many practices from building CAR-T programs at all.

Dr. Graff adds this isn't purely a rural problem: patients near a major metropolitan area can also lose access if their local site loses drug supply or reimbursement standing, since proximity to a city no longer guarantees proximity to care.

Up next, in "Revisiting FACT Accreditation Standards for CAR-T Delivery," the panel traces FACT accreditation back to its transplant-era origins and asks whether its requirements have kept pace with a decade of safety improvements.