(W2) Chimeric Antigen Receptor T-Cell (CAR-T) Therapies: Perspectives and Challenges in Managed Care

With the growing number of cell therapy approvals and an expanding pipeline of innovative treatments, CAR-T therapies are becoming increasingly complex and expensive. Managed care leaders face the critical challenge of balancing rising healthcare costs with patient affordability and access. Effective preparation and budgeting for new cell therapies require close collaboration between managed care teams and their actuarial partners, leveraging data-driven strategies to anticipate financial impacts as these therapies enter the market.

This session will explore the total cost of care and treatment episodes for approved CAR-T therapies, utilizing insights from Milliman’s Consolidated Health Cost Guidelines (CHSD) database, which includes comprehensive medical and pharmacy claims data. From a managed care perspective, faculty will examine how health plans are developing criteria and implementing processes for newly approved CAR-T treatments. Key topics will include variations and best practices in the following areas:
• Prior authorization approaches.
• The role and designation of Centers of Excellence.
• Case management strategies.
• Benefit design challenges.