Chimeric Antigen Receptor (CAR) T-Cell Therapy | Access & Reimbursement | US | 2023

CAR T-cell therapies, such as Gilead / Kite Pharma’s Yescarta and Janssen’s Carvykti, have given new hope to patients with relapsed/refractory (R/R) non-Hodgkin’s lymphoma (NHL) and patients with R/R multiple myeloma. Priced at more than $400,000 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 grows, we explore how MCO pharmacy directors and medical directors (PDs/MDs) approach reimbursement of these expensive therapies for NHL and multiple myeloma and how coverage decisions in their largest commercial and Medicare Advantage plans impact prescribing among surveyed hematologist-oncologists.

Questions Answered

• What factors drive physicians’ choice of a CAR T-cell therapy, both in second line and later lines of therapy?
• How are CAR T-cell therapies covered in commercial and Medicare plans, and what kind of contracts and payment schemes do MCOs commonly use to address the therapies’ high cost?
• What prior authorization requirements and other utilization management controls do payers apply to CAR T-cell therapies, and how do these restrictions affect hematologist-oncologists’ prescribing?
• How will access to CAR T-cell therapies be affected by off-the-shelf bispecific antibodies, such as Roche’s Lunsumio for R/R NHL and Janssen Biotech’s Tecvayli for R/R multiple myeloma? Will MCOs encourage patients to use these therapies before a CAR T-cell therapy?

Content Highlights

Geography: United States.

Primary research: Survey of 100 U.S. hematologist-oncologists; survey of 40 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.