Chimeric Antigen Receptor (CART) T-Cell Therapy | Access & Reimbursement | US | 2022

CAR T-cell therapies have given new hope to patients with relapsed/refractory (R/R) non-Hodgkin’s lymphoma (NHL) and more recently to patients with R/R multiple myeloma. Priced at more than $350,000 per infusion, these therapies also come with unique administrative and budgetary challenges for managed care organizations (MCOs) and providers. As the market for these novel therapies gains ground, we explore how MCO pharmacy directors and medical directors (PDs/MDs) approach reimbursement of these expensive new therapies for NHL and multiple myeloma and how reimbursement decisions in their largest commercial and Medicare Advantage plans impact prescribing among surveyed hematologist-oncologists.

Questions Answered

• What are hematologist-oncologists’ and payers’ assessments of the efficacy and safety of CAR T-cell therapies used to treat NHL, including Novartis’s Kymriah, Gilead / Kite’s Yescarta and Tecartus, and Celgene / Bristol Myers Squibb’s Breyanzi—all for NHL?
• How are CAR T-cell therapies covered in commercial and Medicare plans and what kind of contracts and payment schemes are commonly used by MCOs to address the therapies’ high cost?
• Now that two CAR-T cell therapies are approved for multiple myeloma—Janssen’s Carvykti and Bluebird Bio / Bristol Myers Squibb’s Abecma—how will payers and physicians respond to competition from emerging bispecific antibodies that offer less-complex treatment than CAR T-cell therapies? 
• What prior authorization requirements and other utilization management controls do payers apply to CAR T-cell therapy, and how do these restrictions affect prescribing by hematologist-oncologists? 
• What factors drive physicians’ choice of a particular CAR T-cell therapy and which, if any, CAR-T cell therapies would they prescribe in an earlier line of therapy?

Content Highlights

Geography: United States.

Primary research: Survey of 100 U.S. hematologist-oncologists; survey of 42 U.S. managed care organization (MCO) pharmacy and medical directors (PDs / MDs).

Key drugs covered: Breyanzi, Kymriah, Tecartus. Yescarta, Abecma, Carvykti

Key analysis provided:

• Reimbursement and contracting
• Access and prescribing
• Opportunities and challenges for emerging therapies

Product Description

U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.