CAR T-cell therapy has transformed the outlook for some patients with cancer, but access remains limited by geography, capacity, cost, and administrative complexity. CAR T Vision – a multidisciplinary coalition of patient advocates, medical societies, treatment centers, policy specialists, and other experts – was established to help close that gap. Christine Pfaff, Director of Clinical Initiatives at the Community Oncology Alliance, explains how its new “Vision to Action” Blueprint aims to break down barriers and double the proportion of eligible patients receiving CAR T therapy by 2030.
Can you start by telling us what CAR T Vision is, who is involved, and what it was created to achieve?
CAR T Vision is a multidisciplinary coalition bringing together leaders from North American and European patient advocacy groups, medical society organizations, academic and community treatment centers, as well as health technology assessment, policy and other subject-matter experts.
CAR T Vision was created because, while innovation in the CAR T-cell therapy space continues and there are new indications on the horizon for cancer and other diseases, we’re still seeing eligible patients have trouble accessing treatments. Our goal is to double the proportion of eligible patients treated by CAR T therapy by 2030. We are collaborating across the healthcare system to provide solutions that directly address three key areas: awareness and education, capacity, and sustainable funding and reimbursement.
How did the initiative first come about, and what inspired you to move from discussion to a formal “Vision to Action” Blueprint?
I was invited to join the Vision Steering Committee in late 2025 when I started my new role at the Community Oncology Alliance as Director of Clinical Initiatives. The Vision was formed around the belief that change was overdue when it came to tackling CAR T-cell therapy access. A lot of existing initiatives were already doing great work, but often this was happening in silos. Part of our work as the CAR T Vision is to bring stakeholders together to better collaborate.
By talking with each other, listening to one another, and compiling perspectives, we have created a CAR T Vision to Action Blueprint. It’s a framework for anyone working in the CAR T access space to use as a resource to identify barriers and actions to overcome them.
Why was now the right time to produce this report?
There are many prospective CAR T therapies coming to market in earlier lines of treatment and for other diseases over the next few years, increasing in the number of eligible patients. The current delivery system is not large enough to absorb the volume of patients that we expect as indications expand.
Studies show that even now, a small minority of eligible patients in the US have access to CAR T. If we don’t change this, eligible patients will continue to miss out on these therapies and the potential that they can deliver.
The majority of cancer patients in the US receive care in their community. If we can support community oncology practices and their ability to deliver CAR T locally, we can meet the patient where they are. Consequently, geography will slowly cease to be such an exclusionary factor when it comes to patients accessing CAR T treatment.
What were the biggest challenges in bringing together input from such a wide range of clinicians, academics, patient advocates, and other stakeholders?
Bringing together people from such a diverse range of professional backgrounds has been far more of a benefit than a challenge. Everyone is united by the ultimate goal: patient access. We all want to see more eligible patients benefit from this transformative type of treatment; and as a group, we work together to define and design solutions and ways forward to remove the barriers that stand in the way of patient access.
What are the main access barriers stopping more eligible patients from receiving CAR-T therapy today?
A limited number of treatment centers is a major access barrier today. Patients who do not have transportation or caregiver support to travel a distance to receive therapy may choose other treatment options. This is changing as additional physicians are delivering CAR T to patients in their communities and have the infrastructure to deliver it safely.
By safely expanding treatment into community settings, patients can access CAR T closer to home and remain near their caregivers and support networks. Community oncology practices have decades of experience delivering potentially toxic treatments and managing side effects. However, close collaboration with acute care providers remains important when adverse events cannot be managed in the community. Programs can take different forms: some clinics deliver CAR T and manage most side effects themselves, whereas others rely on hospital partners to address acute needs.
What are the headline recommendations for industry, and where can pharma companies, manufacturers, and other partners make the biggest difference?
We call upon industry to develop products that can provide extended survival and the potential for curative treatment. Including community oncology sites in clinical trials and drug development is important.
When it comes to patient and caregiver education, supporting education and awareness by working with patient advocacy groups to ensure patients and their care partners have access to evidence-based, clear information on CAR T-cell therapy in patient-friendly language is important.
Building on initiatives such as the 80/20 task force by the American Society for Transplantation and Cellular Therapy, we would love to see industry further streamline practice onboarding of products to improve timely access for patients.
And finally, we ask that industry collaborate with policymakers, payers and providers to help develop and implement sustainable financial models supporting timely access to CAR T for patients.
How can policymakers, payers, and health systems help create the conditions for wider CAR-T access?
CAR T cell therapy can be potentially curative, but access to cellular therapies remains limited due to geographic, financial, administrative, and operational barriers.
To improve access, we need policies that work for patients and community providers. This includes fair and transparent reimbursement processes and coverage of CAR T therapy in community oncology settings. Policymakers, payers and health systems need to work together to support access for patients.
We urge policymakers, payers, providers and health systems in the US to work collaboratively to streamline requirements and reduce administrative burden, such as extensive prior authorization processes and single case agreements. Clarity, consistency, and accountability in coverage can build sustainability and increase access.
Are there any countries, treatment networks, community oncology models, or individual programs that you see as useful examples of progress?
There are many outpatient programs currently delivered by independent oncology practices, each safely delivering CAR T-cell therapy in outpatient settings. Virginia Oncology Associates has an established outpatient program using a structured post-infusion monitoring protocol to alert clinicians in the event of a patient need. In the past, these same patients would have had to travel over a hundred miles to access treatment, spending time away from their home, loved ones and their job. So, these programs really make a difference in patient access.
Tennessee Oncology has administered CAR T-cell therapy to patients for over a year in the outpatient setting. While it took time and resources to build their program, the driving factor was a desire to advance access to patients in Tennessee and deliver these products safely to their community. The care team at Tennessee Oncology includes physicians, pharmacists, nurses, financial advocates and others to ensure that patients are well-informed and monitored appropriately.
The first Blueprint focuses on the US. Can you give us a sneak peek at the upcoming European Blueprint - and are there any major differences between the markets?
The European Blueprint will be shared later this year. Like the US, Europe faces an access dilemma involving system capacity constraints and reimbursement challenges. The Blueprint will outline a range of approaches and recognize the work of key organizations that have been addressing these issues for years. Although the European landscape has nuances that do not apply in the US, there are also significant areas of overlap where shared learning could be valuable.
What would success look like for CAR T Vision over the next few years?
We want a CAR T-eligible patient to know that wherever they are in the country, they’re able to have that conversation with their physician and make an informed decision about pursuing the treatment. For community providers, success will mean being able to establish CAR T services that are both operationally and financially sustainable.
CAR T Vision will be measuring year-over-year progress against the three indicators outlined in the US Blueprint: to evaluate improvement in: awareness and understanding, capacity and resources, and financing and reimbursement. Together with all stakeholders, we can help increase access to patients in need.
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