How transplant care can guide cell and gene therapy management

Certain treatments have long served as stress tests for payer operations. That’s certainly true of transplants, which are not only expensive but require complex and careful coordination.

Success depends not only on the surgery itself, but on what happens before and after. A missed immunosuppressant refill or a follow-up appointment scheduled weeks too late can have serious consequences.

Now cell and gene therapies (CGTs) are placing additional pressure on health systems as even more complicated and expensive procedures. The price of chimeric antigen receptor (CAR) T-cell alone averages more than $500,000.¹

Like transplants, CGTs are complex. They require careful quality control and coordination and specialized treatment facilities, which can add significant costs to treatment.

For payers, the challenge isn’t just about managing complex and costly treatments. It’s about whether the right systems are in place to identify risk and collaborate with care teams to support access to these treatments at scale.

Many payers say the U.S. isn’t there yet. In a 2025 survey of payers covering nearly 280 million lives, 95% reported that the American health system isn’t prepared for broad cell and gene therapy adoption. When asked about barriers, respondents cited:

• High upfront costs
• Uncertain long-term outcomes
• Multisite care logistics²

Fortunately, transplant care offers a practical blueprint that can be applied to CGT to answer some of those concerns.  

Transplant patients can face long wait times and tricky recoveries. Outcomes depend heavily on early identification of high-risk candidates and coordinated care across transplant centers with:

• Proven outcomes
• Outpatient clinics
• Pharmacies
• Labs
• And more

The stakes are high. The 30-day readmission rate for lung transplants is a steep 45.4%, signaling how fragile the immediate post-procedure period can be.³ Many of these readmissions stem from issues that might have been prevented if caught earlier.⁴

Better coordination changes what’s possible. As an example, through the Managed Transplant Program and Transplant Resource Services, Optum helps health plans:  

Identify high-risk candidates earlier

Managed Transplant Program nurse case managers guide patients through every step in the process — ensuring that early warning signs don’t go unnoticed.

Enhance patient outcomes

Participation in the Center of Excellence (COE) network is connected with up to a 9% improvement in survival rates and an average 19% reduction in hospital stays.⁵

Control costs

Transplant Resource Services leverages a network of nearly 200 COEs, delivering an average of 60% savings per transplant for commercial patients.⁶

There’s no question about the revolutionary reach of cell and gene therapies. In fact, 99% of oncologists in a recent survey identified CGTs as one of the most important medical innovations of our time.⁷

More than 700 CGTs are now in late-stage development in the U.S., many expanding beyond blood cancer to target diseases that affect millions more patients:

• Wet age-related macular degeneration: 5.7 million patients globally
• Parkinson’s disease: 10 million patients globally
• Type 1 diabetes: 3.8 million patients globally⁸

Yet as CGT use grows, more operational and financial pressure points are being exposed, including:

Limited long-term data outcomes

For many CGT indications, payers are finding it difficult to make coverage decisions with data on durability that doesn’t go beyond five years.⁹

Administrative burden and inefficiency

Prior authorization for CGTs can involve multiple rounds of clinical documentation, peer-to-peer reviews and appeals.

Complex outcomes-based agreements

Manufacturers are increasingly signing on to outcomes-based agreements (OBAs) — such as the CMS CGT Access Model — which tie payment to real-world clinical response. But these agreements require payers and providers to track patients long-term.

Uncertain long-term cost trajectory

For transplants, ongoing immunosuppression, monitoring and complications management continue for years or decades. For CGTs, while the therapy itself is typically a one-time treatment, questions about durability and late effects are still being answered.  

While CGTs are newer treatments, the operational challenges surrounding them are not. The same strategies that help manage transplant care — structured networks, financial protections and hands-on care coordination — can help payers manage the growing CGT wave. Here are 3 strategies to consider:

1. Concentrate complex care through high-performing Centers of Excellence networks

Transplant medicine has long demonstrated a clear volume-outcome relationship: Patients treated at experienced high-volume centers have better outcomes and fewer complications.¹⁰ CGTs are following the same trajectory.

Beyond clinical gains, the Optum Designated CAR-T Network allows payers to reduce cost volatility through bundled pricing and negotiated biologic markups, with reported average savings of 72% for Commercial members and 76% for Medicare compared with unmanaged approaches.¹¹

Centers of Excellence also play a critical role in evidence generation. Centers with standard protocols and larger patient volumes are best positioned to track:

• Toxicities
• Readmissions
• Utilization
• Long-term outcomes

2. Contain financial unpredictability

One of the most immediate concerns for payers is financial unpredictability. A single CAR-T episode averages more than $700,000 and can reach as high as $2 million once follow-up care is factored in. For health plans, that turns a single case into a potentially destabilizing claim.

Transplant programs addressed similar volatility via efforts such as negotiated rates that convert open-ended claims into more predictable costs. As CGT use expands, comparable approaches are becoming essential.

Programs such as the Optum Managed Cell Therapy Program help stabilize this category by converting variable CAR-T claims into a predictable monthly premium that covers the full treatment episode from evaluation to post-infusion outpatient care.

3. Manage the long tail of care

For transplant and CGTs, treatment doesn’t end at discharge. What happens in the weeks and months that follow — symptom monitoring, adherence, follow-up care — often determines whether outcomes last or if complications deter progress.

When medication management, hands-on patient education, logistics support (lodging, transportation) and proactive follow-ups enter the mix, good things can happen.

Programs such as Optum Managed Transplant and Managed Cell Therapy Program help patients manage complex treatments. They connect patients with nurse case managers who handle the overwhelming logistics:

• Coordinating appointments
• Answering urgent questions
• Making sure critical follow-ups don’t slip through the cracks

This hands-on support not only helps patients through an incredibly stressful time but also generates data that can refine care.  

The challenges in transplant care are immediate. Patients are waiting. Complications are emerging. Costs are mounting. Stronger operational capabilities — better information flow, pattern recognition, provider network management, patient support — can improve outcomes and reduce avoidable utilization today.

The challenges in cell and gene therapy management are accelerating. Approvals are increasing. Indications are expanding. Patient volumes are expected to grow tenfold by 2034.¹² Payers that build these capabilities now will be positioned to manage this growth strategically rather than reactively.

Success will come down to the handoffs, the follow-ups, the missed refills, the quiet warning signs that surface days or weeks later. When those pieces aren’t connected, even the best clinical care can unravel. When they are, it can help payers uncover patterns in an often unpredictable field.  

Optum helps payers improve outcomes for both transplant and cell and gene therapy populations through coordinated care management, validated provider networks and dedicated patient support programs