Melody Chang, R.Ph., on what payers miss about bispecifics and CAR-T | HSES 2026

Payers reimburse community oncology practices for bispecific antibodies and CAR-T therapies, but not for the monitoring that makes delivering them safely possible, according to Melody Chang, R.Ph., BCOP, MBA, vice president of pharmacy operations at American Oncology Network (AON). Chang spoke with Managed Healthcare Executive at the 2026 Health System Executive Summit.

These therapies are not cheap, Chang said, so managing them correctly and putting the right infrastructure in place before a program starts is critical. Drug reimbursement isn’t the problem, she said; monitoring is. Her teams spend considerable time on patient education and on nursing triage calls to make sure patients who have been sent home don’t develop fevers, work that payers usually don’t reimburse.

Chang wants payers to recognize that the community is the lower-cost setting compared with academic centers. Overall, she said, the total cost of care for delivering these therapies in the outpatient setting “is much lower,” and AON expects to see better compensation for patient monitoring as a result.

Looking ahead, Chang called the future of these therapies exciting. There are currently 10 FDA-approved bispecifics treating various cancers, she said, and she expects more products and broader indications, including beyond oncology in areas such as autoimmune disease. She also expects more bispecifics to move into earlier lines of therapy and become standard of care whether patients are treated in the community or in a hospital setting.

CAR-T is following a similar path. Chang noted that there are seven FDA-approved CAR-T therapies for blood cancers, some of which have already moved into earlier lines. She expects more community-friendly options to reach the market, such as off-the-shelf allogeneic CAR-T and CAR-NK cell therapies, which carry less toxicity and require less monitoring. “The future is bright,” she said. “The problem is how can we work together to make it happen.”

In this video, Chang discusses what payers and health system leaders should understand about the cost of delivering these therapies and where bispecifics and CAR-T are headed.