Credit: IQVIA
The field of oncology has witnessed a tectonic shift in recent years, driven by the rise of advanced therapies. At the forefront are chimeric antigen receptor T-cell (CAR T) therapies – personalized, living drugs that have redefined treatment paradigms for hematological malignancies. As their clinical efficacy garners headlines, however, a more sobering reality persists: health systems are not yet fully equipped to deliver on their promise.
The IQVIA Institute’s latest report, titled Achieving CAR T Cell Therapy Health System Readiness, examines the infrastructure of Australia, Canada, France, Germany, Italy, Spain, and the UK, including how each is prepared (or not prepared) to support CAR T therapies. The findings lay bare a universal tension: tremendous therapeutic potential weighed against significant logistical, financial, and structural challenges.
From bench to bedside
CAR T-cell therapy begins with extracting a patient’s own T cells via apheresis. These cells are genetically modified to express chimeric antigen receptors targeting cancer-specific proteins, expanded in manufacturing facilities, and then reintroduced into the patient after a conditioning regimen. The therapy has delivered dramatic results in several relapsed or refractory blood cancers, including large B-cell lymphoma, acute lymphoblastic leukemia, and multiple myeloma.
Yet despite first being approved in 2017, CAR T remains far from mainstream. Its complexity demands a multidisciplinary effort encompassing oncology, hematology, intensive care, pharmacy, regulatory bodies, and reimbursement frameworks. Every stage, from referral to long-term monitoring, is a potential bottleneck.
Each country profiled in the report reveals its own unique path toward CAR T readiness, but a few common threads emerge:
Limited treatment center capacity hinders equitable access, particularly in rural or less populous regions.
Referral delays persist because of low awareness among front-line oncologists and the absence of streamlined networks.
Inconsistent reimbursement mechanisms create uncertainty and delay.
Workforce and infrastructure constraints place heavy burdens on already overstretched systems.
Australia
Despite having a publicly funded healthcare model, Australia faces geographic and capacity hurdles. Only seven CAR T centers serve the entire adult population, with four states lacking any facility. Long travel distances, inconsistent state-level funding, and a lack of care coordinators exacerbate inequities. The report recommends a more robust national strategy.
Canada
Canada’s publicly funded but provincially fragmented healthcare system complicates access. While 16 treatment centers exist, patients in rural and remote areas must often travel hundreds of kilometers. The CAR T process is slowed by limited apheresis capacity and bureaucratic complexity in reimbursement negotiations between provinces and manufacturers.
France
France stands out for its strong referral pathways and proactive use of stem cell transplantation networks to support CAR T deployment. However, physicians report being overstretched, and reimbursement covers drug costs, but not all associated procedure expenses. Encouragingly, outpatient lymphodepletion and specialized monitoring centers are emerging as scalable best practices.
Germany
Germany recently unveiled a national strategy for cell and gene therapies, a welcome move given the challenges in referrals and funding approval from sickness funds. Despite a high number of authorized treatment centers, bureaucratic reimbursement hurdles and ICU bed shortages remain key impediments.
Italy
Italy demonstrates both high utilization rates among referred patients and profound disparities across regions. Five out of 20 regions lack a CAR T center, and referrals often depend on personal networks rather than formalized systems. Regional funding complexity, especially for out-of-region patients, significantly delays treatment.
Spain
Spain is a more dynamic example when it comes to policy innovation. With a national plan that undergoes regular evaluation, the country has steadily increased its number of treatment centers and utilizes outcomes-based reimbursement contracts. However, variability in regional implementation and staffing shortages still limit optimal deployment.
UK
The UK’s strength lies in its centralized referral panels and leveraging of allograft networks, but capacity remains a critical concern. Apheresis bottlenecks, ICU constraints, and workforce gaps are compounded by inconsistent guidance and communication across the system. Digital health pilots show promise for outpatient monitoring, but scalability is still in question.
Additional challenges
IQVIA’s CAR T-Cell Monitor, which delivers insights into the market dynamics and collaboration practices in the CAR T cell therapy space, reveals further illuminating disparities, including:
Diffuse Large B-cell Lymphoma (DLBCL) patient treatment rates among those referred range from 39 percent in Canada to 72 percent in Italy.
Average vein-to-vein time (from apheresis to infusion) ranges from 24 days (Canada) to 36 days (Spain).
Referral delays of two months or more are common in the UK, Australia, and Italy, further highlighting the urgency of system reform.
Geographic access varies widely: the average distance from referral to treatment center exceeds 100 km in Spain, Italy, and France, compared to just 35 and 36 km in the UK and Germany respectively.
From bottlenecks to blueprints
The report culminates in a set of recommendations tailored for policymakers, providers, and payers:
National and regional planning. Create living policy frameworks to monitor CAR T adoption and address inequities dynamically.
Comprehensive funding mechanisms. Go beyond drug reimbursement to cover pre- and post-treatment logistics, including travel, ICU capacity, and case management.
Standardized referral governance. Establish regional hubs, develop provider education programs, and deploy eligibility checklists.
Capacity forecasting. Leverage horizon-scanning and pilot outpatient models to ease strain on ICUs and bed space.
Data infrastructure and monitoring. Expand real-world evidence collection via national registries to support outcomes-based contracting and system optimization.
CAR T-cell therapies offer a lifeline to patients with limited options, but the gulf between promise and delivery remains substantial. If healthcare systems are to scale this innovation successfully, investments must shift from pilot programs to systemic change.
The pharmaceutical community has a pivotal role to play: from driving R&D to collaborating with health systems on manufacturing innovations, pricing models, and educational outreach. As CAR T expands beyond hematology into solid tumors and autoimmune diseases, the urgency for health system readiness will only intensify.
The report concludes that there is no better time to act than right now—not just for CAR T, but for the next wave of advanced therapies.
Read more of The Medicine Maker’s coverage of CAR T-cell therapies, including an interview with pioneer of the field Carl June.
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