US: Reducing disparities in access to cell therapy
Equitable access to cell therapy (CT) and hematopoietic cell transplantation (HCT) remains a challenge in the US, due to sociodemographic factors, including race and poverty.109 People from underserved groups often face greater obstacles in accessing these treatments.109
To help close these gaps, the American Society for Transplantation and Cellular Therapy (ASTCT) and the National Marrow Donor Program (NMDP) created the ACCESS Initiative in 2022. The initiative aims to reduce barriers to CT and HCT and ensure equal access to care and outcomes for all patients in need, through changes in practice and policy.110
The ACCESS initiative formed three multi-stakeholder committees to drive the program:109
- Awareness: Increase awareness and education among patients and healthcare providers
- Poverty: Identify patients at high risk of adverse outcomes due to socioeconomic adversity and develop initiatives to improve access and survival
- Racial and ethnic inequity: Improve equity in access and outcomes for all cell therapy recipients, regardless of their race or ethnicity
To support knowledge-sharing, the Awareness Committee established the Regional Physician Exchange Program, to give transplant and hematology or oncology physicians a platform to share experiences, insights and challenges.111 Peer-to-peer learning is a useful tool for physicians to observe best practices and stay updated on the evolving CT and HCT landscape.
In 2023, the Poverty Committee commissioned a survey of all 50 US states to understand Medicaid coverage for CAR T-cell therapy and HCT. The findings revealed substantial geographical variation in coverage and eligibility criteria,112 contributing to the inequalities in access to these treatments. In response, ASTCT and NMPD are creating clinical guidelines on CT and HCT for state Medicaid offices to reference, and liaising with state programs to align their coverage with current clinical standards.110
References
109 Auletta JJ, Sandmaier BM, Jensen E, et al. The ASTCT-NMDP ACCESS Initiative: A Collaboration to Address and Sustain Equal Outcomes for All across the Hematopoietic Cell Transplantation and Cellular Therapy Ecosystem. Transplant Cell Ther. 2022;28(12):802-809. doi:10.1016/j. jtct.2022.09.020
110 NMPD. ACCESS Initiative targets inequities in cell therapy. Available online: https://www.nmdp.org/what-we-do/research/access
111 NMPD. NMPD Regional Physician Exchange. Available online: https://network.nmdp.org/training-education/catalog/nmdp-regional-physician-exchange
112 Auletta JJ, Khera N, DeMartino P, et al. Assessing Medicaid Coverage for Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy: A Project from the American Society for Transplantation and Cellular Therapy and the National Marrow Donor Program ACCESS Initiative. Transplant Cell Ther. 2023;29(11):713-720. doi:10.1016/j.jtct.2023.08.007