Current Market Access to CAR-T Therapies

With the FDA’s February 2021 approval of Bristol Myers Squibb’s Breyanzi, followed by another nod for the drugmaker’s Abecma just a few weeks later, there are now five chimeric antigen receptor T-cell (CAR-T) therapies on the market. Since they require administration at approved treatment centers, CAR-T drugs are most often covered under the medical benefit, though coverage under the pharmacy benefit isn’t unheard of. Among the most advantaged therapies are Novartis’ Kymriah, which holds covered or better status for more than 80% of all insured lives under the medical benefit, and Gilead Sciences’ Tecartus, following behind at 76%. The graphics below show how all five CAR-T therapies are covered under the pharmacy and medical benefit.

NOTES: Access that requires prior authorization and/or step therapy is represented by the abbreviation (PA/ST). Under the pharmacy benefit, the covered lives under commercial, health exchange, Medicare and Medicaid formularies are 170.0 million, 11.7 million, 47.8 million and 69.8 million, respectively. Under the medical benefit, the covered lives under commercial, health exchange, Medicare and Medicaid formularies are 168.4 million, 11.7 million, 49.5 million and 69.8 million, respectively.

SOURCE: Managed Markets Insight & Technology, LLC database as of June 2021.

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