Cell and Gene Therapy: Beyond the Hype, a Scalability Challenge Looms
Despite a growing sense of optimism – with 64% of oncologists now administering cell and gene therapies (CGTs), up from 55% last year – a fundamental bottleneck threatens to stall the revolution in medicine. It’s not a scientific hurdle, but a logistical one: scaling access to these potentially life-altering treatments. Recent findings from InspiroGene by McKesson’s 2025 report reveal that while payer confidence is increasing, and oncologists are becoming more familiar with CGTs, the system isn’t yet equipped to deliver them efficiently or equitably.
The Perception Gap: Provenance and Patient Concerns
A significant barrier remains the lingering perception of CGTs as “largely unproven” (cited by 65% of oncologists) and “risky or experimental” (66% of patients’ views, according to the report). This isn’t necessarily a reflection of the therapies themselves, but a consequence of limited long-term durability data. Payers, understandably, hesitate to commit to substantial reimbursement without five or more years of follow-up data, available for only a fraction of approved CGTs. Bridging this gap requires a concerted effort to expand clinical education and, crucially, to accelerate the collection and dissemination of real-world evidence demonstrating sustained patient benefit.
Reimbursement Roadblocks and the Promise of Novel Payment Models
Cost remains a dominant concern. Three-quarters of oncologists point to insurance coverage and patient out-of-pocket expenses as primary reasons patients don’t receive CGTs after referral. The current healthcare system, as it stands, is often misaligned with the high upfront costs associated with these therapies. However, there’s growing momentum behind exploring innovative payment models – outcomes-based contracts, for example – that could alleviate the financial burden and align incentives. These models, however, face challenges, particularly around ‘member portability’ – ensuring the payer who benefits from long-term outcomes is the one who initially invested in the therapy.
The Qualified Treatment Center (QTC) Conundrum and the Role of Community Pharmacies
The limited number of qualified treatment centers is a critical choke point. Most CGT care is currently concentrated in academic centers and major health systems in densely populated areas, creating significant access barriers for patients in rural or underserved communities. Expanding care into community hospitals and clinics is essential, but accreditation timelines are lengthy. This is where specialty pharmacy services become invaluable. They can help community hospitals navigate the complex reimbursement landscape and logistical challenges, effectively shifting some of the financial and operational risk. As Joe DePinto of McKesson notes, specialty pharmacies can “strengthen local infrastructure and equip community teams to meet CGT standards,” bringing care closer to patients.
Pharmacists: Data Champions for Value Demonstration
Pharmacists aren’t just logistical facilitators; they’re poised to become key data champions. Payers are demanding greater transparency and consistent reporting on patient outcomes. Specialty pharmacies, with their direct patient interaction and established data collection systems, are uniquely positioned to provide structured data, clear clinical context, and ongoing outcomes tracking. This evidence is crucial for demonstrating the value of CGTs and securing broader coverage. The American Society of Health-System Pharmacists (ASHP) offers resources for pharmacists looking to expand their role in specialty pharmacy.
Beyond Oncology: A Future of Expanding Applications
The potential of CGT extends far beyond oncology and rare diseases. Research is rapidly expanding into autoimmune disorders, diabetes, and even heart failure. This broadening scope will exponentially increase demand for both manufacturing and treatment capacity. Successfully scaling to meet this demand requires unprecedented collaboration across the entire ecosystem – manufacturers, payers, providers, pharmacists, and policymakers.
The next few years will be defined by readiness. Community providers will face challenges related to cost, staffing, and operational complexity. However, the opportunity is immense. Staying connected, informed, and adaptable will be paramount for realizing the full potential of these transformative therapies. What are your predictions for the future of cell and gene therapy access? Share your thoughts in the comments below!
