CAR-T cell therapy moves beyond hospitals, raising new questions for payers | AMCP Annual 2026

As chimeric antigen receptor-T (CAR-T) cell therapy continues to evolve, payers are being pushed to rethink both where and how these high-cost treatments are delivered, according to Abby Kim, Pharm.D., and Sneha Sharma, Pharm.D., of Prime Therapeutics. At the AMCP Annual Meeting in Nashville, the two discussed how rapid changes in oncology are creating new opportunities and challenges for managed care.

CAR-T cell therapy has spread into earlier lines of care over the last ten years, going beyond heavily pretreated populations. That shift is happening at the same time as care moves away from hospital stays at large academic centers and toward outpatient clinics and community settings.

According to Kim, senior director of clinical strategy and oncology specialty solutions, this transition is already underway in select regions, often through partnerships between academic institutions and community providers aimed at building the infrastructure needed to safely deliver these therapies closer to patients’ homes. For payers, this evolution raises important questions about site-of-care policies. Historically, many plans mandated the administration of CAR-T therapies at designated centers of excellence.

However, as more community centers begin offering these treatments, payers must decide whether to broaden access or maintain stricter requirements that could limit where patients receive care. Education around recent regulatory and clinical updates, including changes to safety monitoring requirements, will be key to informing those decisions.

Cost considerations are also central to the discussion. Sharma noted that shifting care to outpatient and community settings can significantly reduce overall spending, particularly when compared with inpatient hospital administration.

“When we do see these site of service shifts, we're saving at least 30% of that drug cost,” Sharma said. “It's an exciting time with CAR-T right now, expansion into other disease states, moving up into earlier lines of therapies. But it does give you a lot of considerations in terms of, yes, we need to make these site of service shifts, to make it more accessible, to make it more cost effective.”

That balance between access and affordability will become increasingly complex as CAR-T indications grow. Sharma suggested that payers need to consider new utilization management strategies, including step therapy or other coverage controls, while ensuring that eligible patients are not delayed in receiving potentially life-saving treatment.

As oncology pipelines continue to advance, the speakers said that proactive planning around site of care, reimbursement models and benefit design will be critical to managing both clinical and financial outcomes.