CAR T-cell therapy is a powerful treatment for relapsing-refractory multiple myeloma. It’s a form of gene therapy, which means that it changes the DNA of some of your cells. This helps boost the immune system so it can better recognize and fight cancer.
Although it’s not a cure, CAR T-cell therapy can help you get to remission (no signs of cancer) and live longer. But it has serious risks and is very expensive. It’s only used if other therapies haven’t worked. Here’s an idea of what it costs.
How Much Is CAR T-Cell Therapy?
CAR T-cell therapy can cost over $500,000. What it’ll cost for you or your loved one mainly depends on:
- Your specific needs
- The specific product
- The treatment center
- If you have side effects
The costs can be broken down into these categories:
The CAR T-cell product. This is the process and formula used to make your personalized CAR T cells. The cost generally ranges from $373,000 to $475,000.
Hospitalization. CAR T-cell infusions are usually done in an inpatient treatment center, but there are specialized outpatient centers that do it, too. This part of the bill depends on how long you stay at the medical center if you go the inpatient route and the services you receive. It ranges from $23,000 (outpatient) to $53,000 (inpatient).
Monitoring and management. CAR T-cell therapy can trigger serious side effects, so you may need additional treatments to treat them. This can cost up anywhere from $30,000 to $56,000.
If you don’t live near a treatment center, you might have additional expenses like travel and hotel stays.
How to Check Your Insurance Coverage for CAR T-Cell Therapy
Not all health insurers cover this therapy, but most will cover some of the costs. Coverage may depend on the product and the treatment center. For example, your insurance plan might only cover certain drugs delivered at certain treatment centers. Usually, you’ll still be responsible for your deductible, co-pay, and other costs.
To avoid surprise bills, check your out-of-pocket costs before starting treatment. You’ll want to:
Review your policy. Double check deductibles, copayments, and out-of-pocket limits. See if your insurance company has a list of in-network providers they cover.
Call your insurance company. Confirm CAR T-cell therapy coverage and/or the associated costs, such as:
- Hospitalization fees
- Monitoring with blood tests and imaging scans
- Additional treatments to manage or prevent side effects
Ask if you need prior authorization for this procedure. Some insurance companies also have case managers to help you plan for expenses.
Talk to a financial counselor at the treatment center. They can help you double check insurance coverage, estimate out-of-pocket expenses, and apply for any financial assistance programs or discounts that may be available.
If your insurance denies coverage for CAR T-cell therapy, you have the right to appeal the decision. Support your appeal with additional documentation like medical records, a doctor’s note, and evidence supporting the use of CAR T-cell therapy.
Does Medicare or Medicaid Cover CAR T-Cell Therapy?
Medicare covers it, but Medicaid coverage depends on the state you’re in. The product must be approved by the FDA and the treatment center must be certified by the Centers for Medicare and Medicaid Services (CMS).
How to Get Financial Assistance
Here are some places to start if you need help paying for CAR T-cell therapy:
Raise funds. You can use online platforms (like GoFundMe) or organize bake sales, auctions, and car washes. You should be transparent and honest about your fundraising goals and thank supporters for their generosity.
Contact the drug company. Some drug companies, including the ones that make CAR T-cell products, offer financial aid.
Look into government benefits. The federal government offers special assistance for some people in addition to Medicare and Medicaid. These include the World Trade Center Health and Medicare Savings Programs.
Research copay assistance programs. These are programs that help with the costs of copayments, coinsurance, or deductibles for cancer treatment. They include the Leukemia & Lymphoma Society’s Co-Pay Assistance Program (Myeloma Fund) and the HealthWell Foundation Multiple Myeloma Medicare Access Program.
Explore patient aid programs. These are programs that help with the costs of living expenses, such as rent, mortgage, utilities, or food. Options include the Blood & Marrow Transplant Information Network’s Patient Assistance Fund and CancerCare’s Financial Assistance Program.
Look for local help. There are programs that help with the costs of local services, such as transportation, lodging, or childcare. Ask the social worker at your treatment center for recommendations.
Go far with travel assistance. These are programs that help with the costs of travel expenses, such as airfare, gas, or parking. They include the American Cancer Society’s Road to Recovery program and Mercy Medical Angels.
Show Sources
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SOURCES:
American Cancer Society: “CAR T-Cell Therapy for Multiple Myeloma,” “If Your Health Insurance Claim Is Denied,” “Road to Recovery.”
American Society for Transplantation and Cellular Therapy: “Health Care Resource Utilization and Total Costs of Care Among Patients with Diffuse Large B Cell Lymphoma Treated with Chimeric Antigen Receptor T Cell Therapy in the United States.”
Blood & Marrow Transplant Information Network: “BMT InfoNet Patient Assistance Fund,” “Financial Considerations for CAR T-cell Therapy Patients.”
Bristol Myers Squibb: “Patient Assistance Foundation.”
CancerCare: “Financial & Co-Payment Assistance.”
CARVYKTI: “Patient Resources.”
CDC: “Updated Coverage for Chimeric Antigen Receptor T-cell (CAR-T) Therapy.”
Centers for Medicare & Medicaid Services: “Chimeric Antigen Receptor (CAR) T-Cell Therapy.”
HealthWell Foundation: “Multiple Myeloma - Medicare Access.”
International Journal of Environmental Research and Public Health: “Pride and Prejudice? The Value of Chimeric Antigen Receptor (CAR) T-Cell Therapy.”
JAMA Network Open: “Economic Evaluation of Chimeric Antigen Receptor T-Cell Therapy by Site of Care Among Patients With Relapsed or Refractory Large B-Cell Lymphoma.”
Leukemia & Lymphoma Society: “Co-Pay Assistance.”
Medicare.gov: “Medicare Savings Programs.”
Mercy Medical Angels: “Restoring Hope and Health with Medical Transportation to Healthcare.”
Nature Reviews Clinical Oncology: “Long-Term Outcomes Following Car T Cell Therapy: What We Know So Far.”
