Two months after the U.S. Food and Drug Administration approved the chimeric antigen receptor (CAR) T-cell therapy axicabtagene ciloleucel for the treatment of B-cell lymphomas, only five patients have received the $373,000 treatment. Only 15 hospitals are authorized to administer it in the United States, and waiting lists have grown to at least 200 people; some patients have died before receiving therapy.
"The biggest issue has been insurance, particularly with Medicare and Medicaid," Michael Bishop, MD, director of the cellular therapy program at the University of Chicago Medicine, told Bloomberg. "There's no billing codes for this. It's been difficult, to be very blunt."
MD Anderson Cancer Center, which has more than 100 patients on a waiting list, has started treatment for a few of them, after patients signed waivers acknowledging that they will be responsible for the costs if insurance does not pay. Stanford University Medical Center has decided to take patients regardless of insurance provider.
"My institution is bearing that risk because it's the right thing to do," David Miklos, MD, from Stanford University, told Bloomberg, "but it's a huge risk and it's keeping me awake at night."
Sources: The Scientist, December 18, 2017; Bloomberg, December 14, 2017.