CAR-T Cellular Immunotherapy and Gene Therapy Program

The average billed charges for an infused CAR T case is $1.95M, but CAR T billing is highly volatile and can quickly rise to over $3M a case in certain situations. With the approval of six CAR T therapies and five gene therapies since 2017 and more approvals on the horizon, gene and cellular therapy represent a significant and growing financial risk to health organizations trying to manage rising healthcare costs.

Growing CAR-T Utilization

CAR T Infusions per 100,000 members

FDA approvals of new biologics, in addition to approvals of new indications for existing biologics, and a shift towards earlier line treatment use of certain CAR T therapies, have driven continued increases in CAR T utilization.

Optum commercial contract performance

Average billed and paid charge per Optum Infused CAR T case

Through its effective contracting efforts, Optum’s CAR T Cellular Immunotherapy and Gene Therapy program, manages and reduces the realized expenses and volatility associated with these life-saving, ultra-high cost therapies, delivering financial protection and greater predictability to clients.

Preferred Provider CAR-T Network

We have been negotiating single-case agreements with treatment centers administering CAR T therapies since the first one, Kymriah, was approved in 2017. In 2022 we launched our preferred provider network, made up of 119 FACT accredited centers that are eligible to administer CAR T therapy and were surveyed and qualified based on program structure criteria. Our contractual and extracontractual agreements have historically saved an average of 63% on commercial CAR T cases with even greater savings amongst Medicare and Medicaid cases. Optum has continued to increase its contractual savings rate on CAR T cases by driving down provider mark-ups over the price they paid for the biologic and by containing medical expense. This contracting strategy helps reduce the significant volatility seen in CAR T charges, providing clients with greater predictability and financial protection.

Sources:

1. Optum Claims, Commercial reconciled cases, August 27, 2017 to December 31, 2022.

2. Optum CAR T preferred Provider network sites as of June, 2022