Collaboration, Confidence, and Capacity: The Keys to CGT Adoption

Cell and gene therapies (CGTs) represent one of the most transformative frontiers in oncology today. The U.S. pipeline continues to accelerate, with more than 178 new oncology-focused candidates entering late-stage development in the past year alone, including advances in dual-target CAR T-cell therapies and promising early results in solid tumors.[1][2]

As these breakthroughs move into the clinic, experience among oncologists is expanding. According to the 2025 Cell and Gene Therapy Report, based on research with more than 125 oncologists, 64% are now treating patients with CGTs, up from 55% last year. [1] The number of patients treated has increased from an average of 17 in 2024 to 25 per provider in 2025, a clear sign of growing clinical familiarity.

However, persistent barriers continue to hinder broad adoption. Financial and reimbursement challenges remain top of mind, with 59% of oncologists saying that these factors limit their ability to administer CGTs.¹ In addition, insurance coverage is cited as the top reason why patients referred for CGT treatment often don’t receive it.

Furthermore, among community oncologists, only half (50%) feel prepared to embrace CGT innovation in the next decade, compared with 67% of those in academic medical centers (AMCs).[1] Many cite the complex qualification process for treatment centers as a key barrier to participation.

To fully realize the promise of this expanding pipeline, we must focus on three foundational goals: tackling financial barriers through innovative payment models, building confidence through long-term data, and growing capacity in community settings.

Tackling Financial Barriers with Innovative Payment Models
Financial barriers are one of the most significant hurdles to widespread CGT access. The unique economic profile of these therapies—high upfront cost with potential for durable, long-term benefit—does not fit neatly within a system designed around recurring treatments.

List prices for CGTs can be in the millions of dollars,[3] and although these therapies may replace years of chronic treatment, they require new approaches to financing. As the health system faces these cost challenges, nearly three-quarters (72%) of physicians say insurance coverage is the top reason patients referred for CGT ultimately do not receive therapy.¹ Payers and providers are navigating uncharted territory, balancing uncertainty about long-term outcomes with the immediate need to ensure affordability and access.

To bridge that gap, biopharma companies and payers are exploring new payment models specifically designed for CGTs. Oncologists broadly agree that this could make a difference, with 84% stating that these models will lead to broader adoption of CGTs and 81% agreeing that they are likely to help alleviate disparities in access to treatment.¹ Three of the most promising models include:

• Amortization models, which spread payments over time rather than requiring a lump sum;
• Risk pooling mechanisms, which distribute costs across larger patient populations to minimize exposure for individual payers; and
• Performance-based agreements, which tie reimbursement to patient outcomes and long-term efficacy.

These models represent a shift toward value-based care and shared accountability. However, success will depend on robust infrastructure for data collection, outcomes tracking, and longitudinal follow-up, as well as continued dialogue between stakeholders to align expectations and streamline reimbursement pathways.

Building Confidence with Long-Term Data
Just as innovative payment models can reduce financial uncertainty, strengthening the evidence of CGT’s long-term durability can build confidence among providers, payers, and patients alike.

While oncologists recognize the enormous potential of CGTs, they remain cautious in their optimism. Oncologists ranked “convincing durability of data” among the top barriers to expanding CGT access.¹ While 94% agreed that CGTs can dramatically improve quality of life, nearly two-thirds (65%) still view them as largely unproven.[1]

Many patients express similar concerns. The proportion of oncologists reporting that their patients see CGTs as “experimental or risky” rose from 45% to 66% year-over-year, underscoring the need for broader education and more robust long-term evidence.[1]

Delivering that evidence will require continued collaboration and investment. Biopharma companies and academic research centers must prioritize post-marketing studies and real-world evidence to demonstrate durability and clarify long-term safety outcomes. Consistent follow-up data, especially beyond the two- or three-year mark, can help validate CGTs as durable, reliable treatment options for patients with difficult-to-treat cancers.

Additionally, patient education and advocacy will be vital. Advocacy groups, patient foundations, and manufacturers can play a meaningful role in helping patients and caregivers understand the mechanisms, benefits, and risks of CGTs. Empowering patients to engage in informed conversations with their providers not only builds trust but also enhances adherence, satisfaction, and shared decision-making—critical factors in the adoption of any new therapy.

Growing Community Capacity
If confidence is the foundation of CGT adoption, capacity is the structure that supports it. Today, millions of Americans live hours away from their nearest CGT treatment center,[4] which has significant consequences. Research shows that the likelihood of receiving a CAR T-cell therapy decreases by 40% when patients live two to four hours from a qualified center.[5]

For many patients, receiving treatment often means traveling cross-country, putting their lives on hold, and leaving behind support systems. Patients may be required to remain near the treating hospital for weeks post-infusion, adding further logistical and financial strain for families. These barriers can put potentially curative treatments out of reach.

Despite the clear need, the number of qualified CGT treatment centers has remained essentially flat from 2024 to 2025.[1] Community hospitals and oncology practices, where most U.S. cancer patients receive care, remain underrepresented in this landscape.[6] Addressing this imbalance will require a concerted effort across the healthcare ecosystem. Standardized onboarding protocols, best-practice sharing, and streamlined qualification processes can enable more community-based sites of care to participate safely and efficiently.

Nearly half (46%) of community oncologists cite simplifying the treatment center qualification process as an urgent need.[1] Manufacturers can work closely with providers to reduce administrative burden, create scalable models for training and certification, and ensure that onboarding processes are both rigorous and practical.

Some AMCs are already leading the way by developing comprehensive guidelines for patient selection, administration, post-treatment monitoring, and rapid response protocols. Sharing these frameworks with community sites can accelerate readiness while maintaining patient safety.

Strengthening collaboration between AMCs and community practices will be crucial. By co-managing patients, sharing expertise, and establishing referral-to-return pathways, these partners can create a more integrated model of CGT delivery that preserves continuity of care and keeps patients closer to home whenever possible.

Bringing Potentially Life-Changing Care to Cancer Patients
The science behind CGTs is advancing faster than ever, offering new hope for patients with previously incurable cancers. Realizing this potential will demand collaboration, coordination, and creativity across the healthcare ecosystem.

By building confidence through long-term data, expanding capacity into community settings, and embracing innovative payment models to tackle financial barriers, we can bring these breakthroughs to more patients

CGTs have the power to fundamentally reshape oncology care. The next challenge and opportunity is ensuring that the system around them evolves just as quickly.

__

References:
[1] InspiroGene by McKesson. 2025 Cell and Gene Therapy Report: Advancing the Future of Medicine. October 6, 2025. Online. Last accessed on December 15, 2025
[2] Chenyun Z, Haizhou L. Advancements and future directions of dual-target chimeric antigen receptor T-cell therapy in preclinical and clinical studies. J Immunol Res. 2025;2025:5845167. doi:10.1155/jir/5845167
[3] GlobalData. Cell and gene therapies: Current and future landscape. November 2024. Accessed September 22, 2025.
[4] America Counts Staff. What is rural America? US Census Bureau. Published August 9, 2017. Online. Last accessed on February 28, 2025. l
[5] Ahmed N, Karmali R, Nath R, et al. Chimeric antigen receptor T-cell access in patients with relapsed/refractory large B-cell lymphoma: association of access with social determinants of health and travel time to treatment centers. Transplant Cell Ther. 2024;30(4):190-198. doi:10.1016/j.jtct.2024.04.017.
[6] Tucker, T. C., Charlton, M. E., Schroeder, M. C., Jacob, J., Tolle, C. L., Evers, B. M., & Mullett, T. W. (2021). Improving the Quality of Cancer Care in Community Hospitals. Annals of surgical oncology, 28(2), 632–638. https://doi.org/10.1245/s10434-020-08867-y

Featured image: © 2017 – 2025 Fotolia/Adobe. Used with permission.

DOI