The High List Price of Breyanzi
Breyanzi (lisocabtagene maraleucel) is a brand-name chimeric antigen receptor (CAR) T-cell therapy manufactured by Bristol Myers Squibb. Unlike traditional chemotherapy or oral medications, CAR T-cell therapy is a highly specialized, one-time treatment where a patient's own T-cells are genetically modified in a lab to fight cancer. This complex, customized process contributes significantly to the drug's high price tag. As of May 2024, reports indicated the list price for Breyanzi was over $487,000 for a single treatment.
It is important to remember that the list price is not necessarily what a patient or their insurer will pay. This number serves as the baseline price set by the manufacturer before any discounts, insurance negotiations, or patient assistance is factored in. The actual cost to a patient will be influenced by a wide array of variables, including insurance plan, out-of-pocket maximums, and eligibility for financial aid programs.
Understanding the Total Cost of Breyanzi Therapy
The list price of the medication itself represents only a fraction of the total cost of CAR T-cell therapy. The treatment process involves several stages, each with its own set of expenses. A comprehensive financial assessment must consider these associated medical costs, which can include:
- Leukapheresis: The initial procedure to collect the patient's T-cells.
- Bridging Therapy: Any short-term treatment needed to manage the patient's cancer while the CAR T-cells are being manufactured.
- Conditioning Chemotherapy: A course of chemotherapy administered to the patient before the CAR T-cell infusion to prepare the body.
- Hospitalization and Administration: Patients typically require a hospital stay for the infusion and close monitoring afterward. The length of this stay and whether a patient needs inpatient or outpatient care significantly impacts the total cost.
- Adverse Event (AE) Management: CAR T-cell therapy can cause serious side effects, such as Cytokine Release Syndrome (CRS) and neurological toxicities, which often require extended hospitalization and potentially ICU stays. Costs for managing these complications are a major factor in the overall expense.
Factors Influencing Your Out-of-Pocket Breyanzi Cost
While the list price is daunting, many factors come into play to determine the amount a patient actually pays out-of-pocket:
- Insurance Coverage: The type of insurance a patient has (private, Medicare, Medicaid) will determine the extent of coverage. Even with coverage, deductibles, copayments, and coinsurance apply.
- Financial Assistance Programs: Bristol Myers Squibb offers support programs through Cell Therapy 360, which may offer significant copay assistance for eligible commercially insured patients.
- Treatment Location: The specific hospital or treatment center and its billing practices can affect overall costs.
- Medical Complications: As noted earlier, managing treatment-related side effects can lead to substantial unplanned costs due to longer hospital stays or specialized care.
- Negotiated Rates: Insurance providers negotiate rates with hospitals and manufacturers, which can lower the final cost compared to the list price.
How Breyanzi Compares to Other CAR T-Cell Therapies
Breyanzi entered the market as one of several CAR T-cell therapies available for certain lymphomas. It is helpful to compare it to other prominent CAR T-cell treatments, such as Yescarta (axicabtagene ciloleucel) and Kymriah (tisagenlecleucel), to understand the market context.
| Feature | Breyanzi (lisocabtagene maraleucel) | Yescarta (axicabtagene ciloleucel) | Kymriah (tisagenlecleucel) |
|---|---|---|---|
| Manufacturer | Bristol Myers Squibb (BMS) | Kite Pharma (Gilead) | Novartis |
| Indication(s) | Large B-cell lymphoma (LBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL) | LBCL, FL | B-cell acute lymphoblastic leukemia (ALL), LBCL |
| Launch List Price (Approximate) | ~$410,300 (2021) | ~$373,000 (2017) | ~$475,000 (Leukemia indication, 2017) |
| Estimated 2025 List Price (Approximate) | ~$487,000+ | N/A, varies based on market adjustments | N/A, varies based on market adjustments |
| Processing Time | Reportedly around 24 days | Reportedly two to three weeks | N/A |
Navigating Financial Assistance Programs
For patients facing financial hardship, several programs are designed to help with the costs of Breyanzi therapy.
- Cell Therapy 360®: This is the manufacturer-sponsored program from Bristol Myers Squibb. It assists commercially insured patients with covering their out-of-pocket medication costs, and also helps uninsured or functionally uninsured patients who meet specific income criteria. It provides access and reimbursement support, guiding patients through the complex financial process.
- Bristol Myers Squibb Patient Assistance Foundation: An independent charitable program that may offer free medication to eligible uninsured patients experiencing financial hardship.
- Non-Profit Organizations: Many non-profit cancer support organizations provide financial assistance for treatment, transportation, and lodging, which can help offset some of the associated costs.
To begin the process of seeking aid, patients can visit the Cell Therapy 360 website or call them at 1-888-805-4555. It is crucial to engage with these resources early in the treatment planning process.
Conclusion: Making Informed Financial Decisions
The list price for Breyanzi is undeniably high, reflecting the cutting-edge, personalized nature of CAR T-cell therapy. However, the initial sticker price does not tell the full story. A patient's final out-of-pocket cost is influenced by insurance coverage, associated medical services, and potential adverse events. By working closely with their healthcare team and exploring the comprehensive financial and patient assistance programs available through the manufacturer and other charitable organizations, patients can better navigate the significant financial burden of this transformative treatment. Early and proactive communication with a patient advocate or financial counselor is key to managing the expenses associated with Breyanzi therapy and focusing on recovery.
For further information on support resources, you can visit the Bristol Myers Squibb patient assistance website at bmspaf.org.
