Insurance delays, social barriers, and logistical hurdles are changing how oncologists decide when patients receive advanced cancer therapies like CAR T-cell treatments and bispecific antibodies.
At a recent Institute for Value-Based Medicine panel in Washington, D.C., clinicians explained that access challenges now influence patient outcomes as much as clinical effectiveness. The June 25, 2026 discussion showed that while treatment options for multiple myeloma have grown, delivering them depends on factors beyond the clinic.
Insurance and income dictate treatment timing
Jennifer Kanakry, medical director of the Stem Cell Transplant and Cellular Immunotherapy Program at MedStar Georgetown University Hospital, said most patients receive CAR T-cell therapy late in their treatment. A small group with strong advocacy or better insurance often gets it sooner.
“Maybe they’ve advocated for themselves or have good insurance, and if you remove some of those nonmedical barriers to self-therapy in the D.C. area, we still see several lines of therapy,” she said. The difference shows how social factors, not just medical need, shape treatment paths.
Laura Yarbro, a clinical pharmacy services manager at Maryland Oncology Hematology, identified prior authorizations as a key obstacle. “The first issue we examine is their insurance coverage. After that, we determine affordability,” she said.
These delays change treatment sequences. Mohit Narang, chair of pharmacy and therapeutics at Maryland Oncology Hematology, noted that outpatient settings handle bispecific antibodies more efficiently now, but approvals remain slow. “When we opened studies for outpatient-based bispecifics, more patients participated,” he said, though the process still takes time.
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Logistics and toxicity complicate care
New therapies often require frequent clinic visits, creating burdens for patients. Clinicians often face barriers when scaling or translating newer therapies because patient access relies heavily on social determinants of health and the presence of caregiver support, Kashif Ali, the panel’s moderator and an oncologist at Maryland Oncology Hematology, said.
“How are you deciding on [which] treatment for these patients, or how are you helping [guide] your patients’ journey and making sure that they actually have access to these quick treatments?” he asked, showing the disproportionate access rates among minority communities.
These hurdles affect minority communities more. Ali asked how clinicians guide patients through these barriers. Access gaps involve more than availability—they reflect who can work through the system. Pharmacy teams have stepped in to address these issues.
Pharmacy teams expand their role
Pharmacy teams now handle clinical care, insurance negotiations, and financial counseling.
The shift acknowledges that financial strain can harm patients as much as the disease. Teams have created solutions, partnering with manufacturers for assistance programs and using third-party vendors to find grants. These efforts present financial options early, preventing patients from being overwhelmed by costs. Some patients face access denials after system blocks, complicating care further.
CAR T and bispecifics: promises and pitfalls
CAR T-cell therapy and bispecific antibodies offer major advances, but their rollout has been inconsistent. Kanakry said her team plans treatment sequences carefully, but complications or delays can disrupt them. “We have patients ready for CAR T, but timelines shift due to complications,” she said.
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Despite challenges, the expansion of treatment options has forced changes in care delivery. Narang starts transplant or cellular therapy at diagnosis for multiple myeloma patients but delays it for lymphoma patients to reduce relapse risks. These decisions show that timing, shaped by both biology and bureaucracy, affects outcomes.
Narang also highlighted that many bispecifics, when given long-term, lead to more frequent infections. “At the end of the day, I believe the quality of life matters the most. I think that should be a bigger endpoint, and that should be looked at in the real-world studies,” he said.
Minimal residual disease raises questions
The discussion ended with minimal residual disease as a potential trial endpoint in multiple myeloma. Kashif Ali said MRD-negative status increasingly guides treatment, but its implications remain unclear. “If someone becomes MRD positive after being negative, we don’t know what to do,” he said. “Should we change treatment?”
Narang noted more therapies are approved based on MRD, while Kanakry suggested community oncologists handle monitoring. The uncertainty shows how quickly the field is changing and how much remains unknown.
The biggest question may not be which therapy works best, but who can access it. The panel made clear that the answer depends on systems surrounding care, not just science.
