The True Cost of Running a Community CAR T-Cell Program

In "The True Cost of Running a Community CAR T-Cell Program," the panel turns to the financial side of building CAR-T infrastructure.

Dr. Patt points to Community Oncology Alliance playbooks on administering these therapies in the outpatient setting, developed with leaders in the field, as a resource for practices considering the space. Dr. Graff agrees that ongoing education is essential. She personally hosts quarterly in-services for chemotherapy nurses, physician-aligned nurses, and advanced practice providers, since staff turnover and new therapies constantly change what teams need to know. Her practice maintains checklists for physician teams and patient education, home monitoring equipment, and phone check-ins with patients every six hours during step-up dosing. She notes the CRS and neurotoxicity window for bispecifics is actually more predictable and shorter than commonly assumed, framing bispecifics as a bridge that prepares community oncologists for CAR T.

She suggests that documenting these safety measures for FACT or payers could justify a temporary or accommodated accreditation status for practices with a proven track record. Dr. Patt notes FACT has already begun piloting probationary or preliminary status for practices entering the space, though she believes more support is still needed.

Asked about the operational costs involved, Dr. Graff explains that safety requires real spending: staffing, the FACT application process itself, and stocking tocilizumab, which can run $11,000 to $13,000 per dose even with a biosimilar available, with at least two doses kept on hand. Overnight and weekend monitoring calls, off-hours clinic visits, and ongoing staff education all add cost. When a patient has an overnight event that doesn't require a hospital visit, her team opens the clinic in the middle of the night rather than send the patient to the emergency room, which keeps them out of the hospital but still carries a real staffing cost. For physician-owned groups, she says, that expense can be prohibitive, which is why some practices still avoid bispecifics entirely.

Our next episode, "Scaling CAR T-Cell Therapy to Community Hospital Sites," turns to the practical mandates behind building a community program from the ground up.