WHEN A MILLION-DOLLAR TREATMENT IS WORTH IT What Employee Benefits Professionals Should Know About CAR-T Therapy October 2026
Executive Summary
Personalized medicine continues to advance, quickly transforming the treatment of complex diseases by moving beyond therapies designed for broad patient populations toward interventions tailored to individuals. Among these advances is Chimeric Antigen Receptor T-cell (CAR-T) therapy. This treatment genetically modifies a patient’s own immune cells to recognize and destroy cancer cells. For patients with certain advanced or treatmentresistant cancers, CAR-T has produced remarkable outcomes, including durable remissions that were previously difficult to achieve. With any new treatment, associated costs have not seen the same, rapid progress. However, evaluating CAR-T solely by its upfront price can overlook the broader economic impact of advanced cancer care. With time, it is anticipated these treatments will emerge in employer sponsored plans, making it approachable and more affordable. Strategic planning and proactive clinical management can help plan sponsors navigate this evolving landscape while balancing patient access with responsible stewardship of healthcare dollars. Ultimately, CAR-T illustrates a broader shift in healthcare: the most expensive therapies cannot be evaluated by acquisition cost alone. Employers must increasingly consider clinical outcomes, long-term healthcare utilization, patient experience, and the potential for durable survival when evaluating emerging treatments.
Sam Ritter, MD Medical Director, Higginbotham
Novel medical interventions can cost hundreds of thousands of dollars, if not millions. These therapies represent some of the largest claims many employers will ever see, they can also produce long lasting remissions in patients who have few remaining treatment options. The upfront cost may ultimately prove to be substantially less than the lifetime cost of treating the advanced disease. “Personalized medicine” sits at the forefront of clinical investigation and research. Medical innovation has increasingly been directed toward highly individualized therapies tailored to a specific patient. Historically, researchers designed therapies and interventions to improve outcomes across large populations, making clinical trials geared towards determining whether treatment produced an overall benefit in a population. As our understanding of disease at the molecular level has grown, it has become increasingly clear that pathology can be as unique as the person affected. As a result, cutting edge interventions are now being designed to target an individual’s unique disease process. These therapies are difficult to create at scale, are highly complex, and are consequently expensive.
Successful examples of this
precision-based approach include:
Gene therapy Replaces or corrects a faulty gene with a working copy, often in a single treatment.
As much as $4.5 million per patient
Tumor sequencing Reads the DNA of a tumor to identify mutations that can be matched to a targeted drug.
$3,000 – $6,000 per test
Pharmacogenomics Uses a patient’s genetics to predict how they will respond to a drug, guiding selection and dose.
$250 – $2,000 per panel
Chimeric Antigen Receptor T-cell (CAR-T) therapy Re-engineers a patient’s own T-cells to recognize and destroy their cancer.
$550,000 – $800,000 per episode of care
What is CAR-T Therapy? Chimeric Antigen Receptor T-cell (CAR-T) therapy is a marvel of modern medical ingenuity. The traditional paradigm for treating cancer involves medications aimed at destroying cancer cells. Unfortunately, many healthy cells are damaged in the process. CAR-T therapy seeks to train a patient’s own T-cells to identify abnormal cancer cells, marking them for destruction by the immune system. If successful, the immune system selectively destroys the cancer while largely sparing healthy tissue.
The process is intensive but revolutionary. A patient must undergo a procedure called leukapheresis, where T-cells are filtered from the blood while the remaining blood is returned to the body. The T-cells are then transferred to a specialized facility where a viral
vector introduces DNA into the cells. This DNA instructs the T-cells to produce a Chimeric Antigen Receptor (CAR) on their surface. This receptor is designed to recognize cancer-specific proteins (e.g., CD19) associated with the type of cancer affecting the patient. Over the next few weeks, the CAR-T cell population is grown and expanded in the laboratory. Before they can be infused, the patient receives chemotherapy to reduce some of their existing T-cells and create space for the engineered cells to expand. The CAR-T cells are then infused and circulated throughout the body, identifying cancer cells. Once CAR-T cells recognize their target, they recruit the immune system to destroy the cancer cells. Some of the CAR-T cells remain in the body to continue immune surveillance. If everything works according to plan, the cancer may remain in remission indefinitely after a single CAR-T treatment.
How the CAR-T Process Works: Out of the patient, back to the patient Leukapheresis
T-cells are filtered out of the blood; the rest is returned to the body. 1
Ongoing surveillance
6
2
Some CAR-T cells remain on patrol. After a single treatment, remission may last indefinitely.
Re-engineering
In a specialized facility, a viral vector inserts DNA that tells the T-cell to build a cancer-seeking receptor.
The CAR-T Journey Infusion
5
3
The CAR-T cells are infused and circulate, recruiting the immune system to destroy the cancer.
Expansion
Over the next few weeks the CAR-T cell population is grown in the laboratory. 4
Lymphodepletion
Chemotherapy reduces existing T-cells and creates space for the engineered cells to expand.
Who Receives CAR-T? CAR-T therapy has been approved by the FDA to treat the following cancers: Diffuse large B-cell lymphoma
Acute lymphoblastic leukemia
Multiple myeloma
Mantle cell lymphoma
Follicular lymphoma
Chronic lymphocytic leukemia
It is a highly specialized treatment reserved for carefully selected patients. CAR-T carries meaningful risks, including the invasiveness of leukapheresis, immunosuppression with subsequent infections, low blood counts, and neurologic toxicity.
CAR-T carries meaningful risks
The invasiveness of leukapheresis
Immunosuppression with subsequent infections
Low blood counts
Neurologic toxicity
CAR-T is usually reserved for patients with recurrent disease or for those whose cancer has failed to respond to first line therapy, though many patients respond well to first line treatments such as chemotherapy, antibody therapy, or other personalized therapies. Tens of thousands of patients are diagnosed each year with cancers for which CAR-T may be an option, but only a small fraction of those individuals will ultimately receive it.
As our understanding of disease at the molecular level has grown, it has become increasingly clear that pathology can be as unique as the person affected.
How effective is CAR-T therapy? The effectiveness of CAR-T therapy varies by cancer type, but the results have been remarkable. Consider three examples:
1
2
3
Diffuse Large B-cell Lymphoma (DLBCL)
B-cell Acute Lymphoblastic Leukemia (ALL)
Multiple Myeloma (MM)
Patients with DLBCL who failed second- or third-line therapy had a median overall survival of only 6 to 8 months, and very few survived five years.
Patients with recurrent or refractory B-cell ALL had a median survival of only 4 to 8 months.
Similarly, patients with multiple myeloma who exhausted therapies such as proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and stem cell transplant had a median survival of only 9 to 12 months.
Survival before CAR-T therapy became available.
A New Baseline for Survival CAR-T therapy has fundamentally changed expectations for many of these patients. Today, approximately 40 to 45% of DLBCL patients who have failed first line therapy remain disease free five years after CAR-T treatment, compared with fewer than 10% before CAR-T became available. Likewise, meaningful numbers of patients with recurrent or refractory B-cell ALL now achieve remissions lasting for years.
Patients with multiple myeloma have demonstrated response rates approaching 90 to 95%, with approximately half achieving a complete response and four-year survival approaching 60%.1,2,3
Five-year survival, diffuse large B-cell lymphoma Patients who failed first-line therapy and remain alive and disease free five years later.
Before CAR-T After CAR-T Bars are drawn to a 50% scale. Figures as cited above.
fewer than 10% 40 to 45%
The Economics $400,000 – $500,000 Creating the CAR-T product from the patient’s own T-cells
+
$150,000 – $300,000 Leukapheresis, chemotherapy, infusion, labs, imaging, physician fees and follow-ups
The most expensive part of the CAR-T treatment process involves creating the CAR-T product from the patient’s own T-cells. This process alone can cost $400,000 to $500,000. Leukapheresis, lymphodepleting chemotherapy, the CAR-T infusion, laboratory work, imaging, physician fees, and follow-ups can add another $150,000 to $300,000. This brings the total episode of care to approximately $550,000 to $800,000. Hospitalization for treatment related complications can increase these costs even further. Compare those costs to the alternative. Consider a patient with DLBCL who has refractory disease and an average life expectancy of less than one year. During that time, the patient may require ongoing imaging, biopsies, chemotherapy and immunotherapy infusions, hospital admissions, radiation therapy for symptom management, emergency care, ICU admission, antibiotics, specialty
=
$550,000 – $800,000 Total episode of care
physician consultations, transfusions, and hospice services. The cost of that care can easily exceed $500,000 in a single year. Some patients will survive longer and others less, but the financial impact over the course of the disease can ultimately surpass the cost of CAR-T therapy. CAR-T should not be compared with doing nothing or with the cost of a single chemotherapy regimen. Patients eligible for CAR-T often face an alternative course involving multiple lines of treatment, repeated imaging, transfusions, hospitalizations, serious infections, and in some cases, stem cell transplantation. That conventional pathway can itself cost several hundred thousand dollars while offering a relatively low likelihood of durable survival. CAR-T generally increases near term spending, but for patients who achieve a lasting remission, it may replace years of recurring cancer treatment and hospital care.
One episode, or one year of the alternative CAR-T episode of care
The conventional pathway
$550,000 – $800,000
can exceed $500,000
A single treatment. For patients who achieve a lasting remission, it may replace years of recurring cancer treatment and hospital care.
vs
In a single year — imaging, biopsies, infusions, admissions, radiation, emergency and ICU care, transfusions, and hospice.
Figures as stated in the text above. The conventional-pathway figure describes a patient with refractory DLBCL and a life expectancy of less than one year.
Why Employers Should Pay Attention CAR-T is one example of an expensive, personalized therapy with tremendous upside. It is challenging employee benefits programs to think differently about health care spending. Large, front-loaded costs may ultimately reduce downstream medical expenses while dramatically improving patient outcomes. These therapies are forcing the health care industry to reconsider how breakthrough treatments are financed so that members have access to life changing, and sometimes lifesaving, care. The incidence of expensive, personalized, cell-based therapies is no longer vanishingly rare. In 2017, there were only 70 CAR-T treatments in the Unites States. By 2022, there were over 4,000, and the incidence continues to rise rapidly. This translates to approximately 1.3-1.5 CAR-T treatments per 100,000 people. The FDA-approved conditions and indications for CAR-T therapy are also expanding. A recent peer-reviewed analysis showed that the proportion of Americans with advanced/metastatic cancer who were eligible for CAR-T therapy in 2017 was 2.7%. By 2023, that percentage had risen to 3.9%, a 44% increase. Indications for CAR-T therapy only continue to expand as physicians realize that starting this treatment earlier may be more beneficial. Over time, this treatment will become more common and streamlined as indications will expand, and therapy will start earlier in the disease process. It is much more likely that CAR-T treatment will impact employer-sponsored plans in the future.
Employers who plan ahead for these expenses are better prepared for when they occur. Effective care coordination helps direct patients to centers of excellence, which often have more experience managing CAR-T therapy, offer competitive pricing, and have better clinical outcomes due to greater expertise in navigating the complexity of this care. Identifying these members early is equally important. Tracking diagnoses through claims history as first and second line therapies are exhausted allows case management teams to become involved sooner and better support both the patient and their treating physicians. Directing members to appropriate sites of care and encouraging preventive care whenever possible may also reduce unnecessary emergency department visits and avoidable disease exacerbations. For self-funded employers, thoughtful benefit design can help weather these high-cost events. Maintaining adequate stop loss coverage while implementing a thoughtful clinical review process helps ensure that CAR-T is available when appropriate while confirming that the correct patients receive the right therapy at the right time. Numerous third-party solutions also exist to help employers manage chronic disease and cancer care. For patients still receiving chemotherapy and not yet candidates for CAR-T, exploring more convenient sites of care for chemotherapy and immunotherapy infusions can improve patient experience while reducing costs significantly. In some cases, at home infusions may cost as little as one fifth of the price of receiving the same treatment in a traditional health care setting.
Four levers employers can pull 1
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4
Direct care to centers of excellence
Identify members early
Maintain adequate stop loss
Explore alternative sites of care
More experience, competitive pricing, better outcomes.
Track diagnoses through claims history as first and second line therapies are exhausted.
Pair it with a thoughtful clinical review process.
At-home infusions may cost as little as one fifth of a traditional setting.
Planning ahead, reviewing claims history in real time, embedding proactive clinical solutions, and designing employee benefits thoughtfully can help employers fully support their members while protecting the financial health of their plan.
Let’s Talk About This Our brokers and consultants are available to help reduce or avoid potential risks to your company, evaluate solutions that offer desirable benefits to your employees, and align with your budget and goals. Learn how Higginbotham can help you obtain the best program design and cost plan for a secure and healthy future.
Works Cited: 1. Cappell KM, Kochenderfer JN. Long-term outcomes following CAR T cell therapy: what we know so far. Nat Rev Clin Oncol. 2023;20(6):359-371. doi:10.1038/s41571-023-00754-1. 2. Locke FL, Miklos DB, Jacobson CA, et al. Long-term survival after axicabtagene ciloleucel as second-line therapy for large B-cell lymphoma (ZUMA-7). Nature Medicine. 2025. doi:10.1038/s41591-025-03753-3. 3. Mohan M, et al. Long-term follow-up of B-cell maturation antigen-targeted CAR T-cell therapy in relapsed/refractory multiple myeloma. J Immunother Cancer. 2025;13:e010687. doi:10.1136/jitc-2024010687. 4. Haslam A, Hoeg TB, Prasad V. Estimation of eligibility for and response to CAR-T therapy in the United States. Blood Adv. 2024;8(4):1032-1036. doi:10.1182/bloodadvances.2023011184. 5. Westin JR, Oluwole OO, Kersten MJ, et al. Survival with axicabtagene ciloleucel in large B-cell lymphoma. N Engl J Med. 2023;389(2):148-157. doi:10.1056/NEJMoa2301665.
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