The financial burdens of CAR T-cell therapies
CAR T-cell therapy costs can be extremely unpredictable for managed care organizations. Billed charges for a CAR T episode can quickly rise to $2 million or more.*
Optum manages the clinical and financial aspects of your CAR T-cell therapy cases through the Managed Cell Therapy Program. We can help advance your strategy for controlling costs, mitigating risk and improving patient outcomes.
Access to high-quality CAR T-cell therapy facilities
Designated CAR T network
Optum connects individuals to the nation's top CAR T-cell therapy centers through its Designated CAR T Network. The network is reviewed annually to maintain high standards and continues to grow to meet evolving patient needs.
Quality in client service
Optum specialized clinical case managers assist members through the cell therapy process, including evaluation, pre-infusion, infusion, post-infusion, transportation arrangements, lodging and aftercare. Our dedicated Optum nurse case managers assist members in making informed decisions about their care through:
- Assistance in navigating the health care system
- Resources for choosing where to get care
- Designated CAR T network education and referrals
- Medical director support
- Treatment education
Predictable cost containment
CAR T therapy utilization and resulting costs can be difficult to predict. Our managed solution offers a capitated arrangement to shield groups from unexpected financial exposure — trading cost volatility for a stable, predictable premium. Backed by the Optum case rate provider contracting strategy, clients typically see average savings of 72% for commercial and 76% for Medicare through bundled pricing and reduced biologic markups.**
Key benefits
Optum allows you to outsource the risk for CAR T-cell therapy cases. You simply pay a monthly premium, and we’ll pay claims that result from CAR T cases.
Less volatility
Reduce volatility by making CAR T-cell therapies a more predictable expense, freeing up capital reserves.
Financial risk mitigation
Cover related services from one day pre-infusion through a maximum of 90 days post-infusion.
CAR T coverage
Supporting all FDA-approved biologics for treatment of leukemia, lymphoma, multiple myeloma or other blood cancers at the time of approval.
Inclusive coverage
Cover expenses for evaluation, cell harvesting, preparative therapy, labs, prescriptions, post-infusion care, readmission, outpatient care and travel and lodging.
Value-driven clinical support
Our clinical team provides members with expert guidance through complex health care navigation. We empower informed decisions and elevate outcomes — driving value for both members and your plan.
Cost reduction
Significantly reduce health reinsurance premiums and mitigate future trend increases through a product designed to eliminate deductibles and ADMs while minimizing the financial burden of dual deductibles across consecutive years.
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Product information and resources
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Fact sheet
Understand CAR T-cell therapy options
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*Optum book of business, 2023.
**Results not guaranteed. Individual plan results will vary. Optum Claims, all CAR T cases, Aug. 27, 2017, to Dec. 31, 2023.