Costs and Payer Questions
A patient-specific and complicated manufacturing process such as CAR T is expected to be costly. The cost of the first CAR T cell therapy from Novartis is set at $475,000 per treatment according to Novartis. Only one treatment is needed. Kite Pharma/Gilead has said their single CAR T therapy will run $373,000 per treatment regimen. The commercial potential of CAR T-cell therapy could exceed $1.5 billion by 2020.
What factors push up the cost of CAR T?
- Specialized facilities and healthcare providers
- Manufacturing costs
- Possible need for intensive care post-infusion due to serious adverse events
- Prolonged hospitalization
What about reimbursement? Feinberg and colleagues suggest that a bundled payment approach, where a limited number of facilities offer treatment with contractual payment agreements may be one reimbursement strategy, similar to the current precedent set by allogeneic HSCT.
As reported by FiercePharma in September 2017, Novartis “has already established an outcomes-based approach to reimbursement for Kymriah with the Centers for Medicare and Medicaid Services (CMS) that allows for full payment only when these patients respond to Kymriah by the end of the first month after treatment.” Patient assistance for uninsured and underinsured patients is also in place.
However difficult or expensive the therapy is, the success rate of CAR T cell therapy has been impressive in patients with refractory leukemias and lymphomas, with some response rates in the 80% range.
Learn More: Learn More: CAR T-Cell Therapy: A Healthcare Professional’s Guide – Commercialization
