Before we get into the meat of this, a pre-amble:

Waddup fellow nerds - TLDR Biotech is still alive (somehow, sort of)!

It’s been a bit of time since my last post detailing how we’d be taking a big pause on the current news compilation strategy - it’s been just over a month!

What is that, like 10 years in internet time?¹  

Despite the eons that have passed, I’m not giving up the ghost just yet. TLDR Biotech as a “brand”, idea, whatever, is still alive and kicking, at least as long as I have something to say about it.

So while I’m busy with way too many projects (more word on those on my LinkedIn profile in due course - connect with me!)² , I’ll still make some time for longer form writing - with the post below being one of those.

Originally published on the Signals Blog a few weeks ago, I waded into the world of CAR-T pricing - specifically unique paths to “cheaper” cell therapies, as well as financing strategies to make these ultra-expensive therapies more affordable. Read on below!

(Shout-out to Stacey Johnson at CCRM for this writing opportunity - you’re the best!)

Lowering CAR T costs: Paths to more affordable cell therapies

By Anis Fahandej-Sadi; Originally published on Signals June 5, 2025

Cancer treatment has advanced dramatically, but a central challenge remains: the newest tools in our arsenal are shockingly expensive. CAR T-cell therapies exemplify this—they’re amazing at fighting blood cancers, but a single treatment costs upwards of US$500,000.³ These costs are prohibitive, even in wealthy nations, so we need strategies to drive down prices and create innovative payment models to increase accessibility.

Paths to “cheaper” cell therapy with thoughts on creative financing

A quick note that our focus here is on bringing down pricing for existing, approved cell therapies, with a primary focus on CAR T. As much fun as it is to discuss allogeneic or in-vivo approaches, those are beyond the scope of this specific discussion as they’re not the dominant approach for CAR T; autologous manufacturing is currently the gold standard.

Approach 1: Bring Manufacturing Home

The standard CAR T manufacturing process is highly manual and labour-intensive, with skilled workers’ wages driving up costs. Even with automation (being pursued by companies like Cellares, Ori Biotech, Multiply Labs and OmniaBio), these systems and approaches are still too expensive for low- and middle-income countries; and specifically for Cellares, the systems themselves are not for sale.⁴

So for a low- or middle-income country, localizing production offers a game-changing strategy for reducing costs. ImmunoACT in India is a leader in this approach, developing a homegrown CD19 CAR T-cell therapy tentatively priced at just $50,000 compared to the typical $300,000-$500,000.

Brazil is following a similar playbook through a partnership between the Oswaldo Cruz Foundation (Fiocruz) and U.S.-based non-profit Caring Cross. By utilizing some novel approaches (such as a soluble antibody for T-cell selection rather than a column-based selection step) and establishing domestic production capabilities, they’ve managed to produce CAR T-cell therapies for around $30,000 per patient. It’s a compelling model that Caring Cross is planning to expand to both Turkey and the Middle East.

Approach 2: Point-of-care manufacturing 

Another potential cost-cutting strategy, which eliminates the complex finished product supply chain entirely, is to produce CAR T-cell therapies where patients receive treatment.

For example, a Barcelona hospital led with this approach, manufacturing its own CAR T for approximately $97,000 per patient—still expensive by global standards, but a significant reduction from commercial alternatives.

The price drop makes sense: no expensive (cryopreserved) shipping of living cells, no intermediary facilities, and faster turnaround times.

The hold-ups here come from needing both specialized facilities and staff. These can be partially alleviated by utilizing specialized technologies, with companies like Galapagos developing “decentralized” CAR T platforms. For extended reading, I’d recommend checking out this report.

Reality check: Purchasing power matters

While a nearly 10x price reduction enabled by Indian biotech ImmunoACT’s CAR T-cell therapy (from $500,000 to $50,000) sounds impressive, purchasing power parity analysis reveals the relative burden is smaller than raw numbers suggest.

According to IMF data, India’s PPP-adjusted GDP per capita stands at $12,130, while the U.S. sits at approximately $86,000. This means that India’s “affordable” $50,000 CAR T-cell therapy represents 412 per cent of PPP-adjusted GDP per capita compared to 581 per cent for the U.S. $500,000 therapy.

In other words, when accounting for local purchasing power, a family in India (more precisely the Indian medical system) facing a $50,000 CAR T bill experiences roughly 70 per cent of the economic burden that an American family faces with a $500,000 bill.

This might seem discouraging as the improvement appears less dramatic when adjusted for local economics. However, this still lowers access barriers, and the real measure of success is how many more patients gain access to life-saving treatments.

Before ImmunoACT, CAR T access in India was essentially impossible; now, patients have a viable option.

Creative financing: Beyond traditional models

Even with reduced manufacturing costs, $30-50k therapies remain out of reach for many patients and strain health-care systems. This reality has sparked innovative thinking around payment structures that move from “pay upfront, hope it works” toward arrangements aligning costs with outcomes.

Approach 1: Pay-for-performance - Results first, payment second

One promising (and already implemented) model ties payment directly to treatment success. Under these arrangements, health-care systems or insurers pay little or nothing upfront, with the bulk of payment triggered only when patients hit specific milestones—perhaps six months of cancer remission, or survival past a certain timeframe.

Novartis pioneered this approach back in 2017 with its CAR T-cell therapy Kymriah, saying that they wouldn’t collect any payment unless a therapeutic response was recorded within a month.

Approach 2: Spread the burden - Extended payment plans

Another approach treats expensive cell therapies more like mortgages than medical procedures. Instead of requiring $400,000 upfront, these models allow health-care systems to pay over multiple years—potentially spanning a decade or more.

This approach recognizes that successful CAR T-cell therapies can provide benefits lasting years or even a lifetime. If a treatment keeps someone cancer-free for 20 years, why not spread the payment across that same timeframe? It makes the immediate financial burden more manageable, while still ensuring manufacturers recover their costs.

The implementation challenge lies in the details: What happens if the patient switches insurance plans, moves countries, or, unfortunately, doesn’t survive the full payment period? Especially relevant for countries where private insurance (like the U.S.) is the dominant mode of medical care coverage. In these cases, some proposals suggest insurance-backed guarantees or government underwriting to address these complications.

Approach 3: Money-back guarantees - The warranty model

A third approach applies consumer product thinking to cell therapy, essentially offering warranties on cancer treatment. Patients and insurers pay the full price upfront, but receive partial refunds if the treatment fails to maintain its effectiveness over time.

This model acknowledges that even successful CAR T-cell therapies can lose effectiveness as cancer adapts or returns. Under a warranty system, if a patient’s cancer returns within two years, they might receive a 50 per cent refund. If it returns within five years, perhaps 25 per cent. The specifics would vary, but the principle remains: therapy developers stand behind their products’ long-term performance.

Combining models for maximum impact

The most sophisticated approaches combine multiple strategies: minimal upfront payment; milestone-based payments tied to outcomes; and warranty provisions for long-term effectiveness. This diversifies risk across patients, health-care systems and therapy developers, while ensuring everyone has an investment in its success.

The early evidence suggests these models work: both Novartis and Gilead have successfully implemented outcome-based agreements with various health-care systems.

The Road Ahead

Despite initial sticker shock, cell therapy (especially CAR T) adoption is increasing and innovations are being made across the entire supply chain and around the world.

The biggest questions aren’t centred around whether cheaper CAR T is possible – it is – but:

1. What is the lower bound of affordability and cost for CAR T and cell therapy as a whole?

2. How do cell therapies remain competitive (from a therapeutic and economic perspective) against other existing, and emerging, modalities?

The path forward likely involves a hybrid of all the things discussed here: local manufacturing for established markets, point-of-care and automated systems for specialized centres, and innovative payment and financing models to reduce burdens on individual families and health-care systems.

As more cell therapy developers adopt these creative payment structures, and as manufacturing costs continue falling, we may finally see CAR T-cell therapies reach their full potential as truly accessible, life-saving treatments.

1  I’ve also figured out footnotes in the meantime, and since I’m writing long form content here, you’ll be subjected to them!

2  And who knows, maybe(???) the news compiling will make a comeback - I’ve had a lot of people reach out, as recently as yesterday, saying how much they miss that format. At a certain point you need to think “did I give up on a good thing too early”, you know? I wouldn’t be entertaining this idea if (1) there hadn’t been this consistent response missing the newsletter and (2) some of the zany automation tools I’ve learned over the past month. Not making any promises, just a thought here!

3  All costs are in US dollars, unless specified otherwise. 

4  Cellares is instead building out “IDMO (Integrated Development & Manufacturing Organization) Smart factories” where Cellares still owns the systems and facility but sells cell therapy manufacturing services. If we assume favourable economics, there’s a non-zero chance they may set up these facilities in countries like India or Brazil.