Insurance companies, Medicare slow to pick up tab for pricey but potentially life-saving treatment

WGN News first told you about CAR-T, a new and potentially life-saving cancer treatment, back in October. The cell therapy uses a patient’s own immune cells, and its potential had doctors in awe and patients scrambling for a chance to try it.

Now, as we meet one of the first patients here in Chicago, we are learning about a new wrinkle that is keeping the therapy out of reach for many.

Mary Zajas is the first patient at University of Chicago- Medicine to receive the treatment, named Yescarta, outside of a clinical trial.  T-cells, taken from Mary during an initial blood draw more than two weeks ago, are treated in a lab, re-engineered and super-powered to seek and destroy the cancer cells streaming through her blood – then sent back for infusion.

There were not just a few, but millions of them, dripping into her bloodstream the morning WGN News was there. It was an emotional day for the 61-year-old who has battled three relapses of non-Hodgkin lymphoma since her diagnosis in 2015.

“It feels great it feels great and I feel very privileged,” Mary said.

Her medical team gathered to witness the event – and for good reason. Before CAR-T therapy, survival rates for those who experienced a recurrence of large b cell lymphoma were 8 to 10 percent. With the new treatment there has been a huge leap – 40 to 50 percent of patients experience a complete response – no sign of disease for months and counting.

“This is why I get up in the morning,” said Dr Michael Bishop, medical oncologist at the University of Chicago- Medicine.  “From the day one you started to see the responses, you see hope …”

But with the excitement there’s frustration. Since Yescarta was approved by the FDA in October, only six patients – including Mary – have received the treatment since that time.  That’s across the entire United States. Right now, the wait list is 12 deep at University of Chicago medicine. Across the country there is a total of about 200 patients waiting for the green light.

“It’s been insurance issues,” Dr. Bishop said. “It’s a brand new therapy and it is an expensive therapy. It took hundreds of millions to develop it and where they send it to is a plant that costs hundreds of millions of dollars so there is a cost associated with this.”

At $373,000 per dose – patients need just one – some insurance companies have been slow to approve or reimburse the cost. That leaves medical oncologist Dr. Bishop and his team to work the phones – pleading for their patients – some running short on time fighting the aggressive disease.

“Lymphoma doesn’t sit to wait for approval. it’s growing so there is a narrow window to get the patients treated,” he said.

WGN News asked the drug’s maker, a division of Gilead Pharmaceuticals called Kite, about the cost and delays.  They said: “We are confident that Yescarta will be covered by payers. We anticipate the payer mix to be about 50 – 60% Commercial and about 1/3 Medicare.”

Mary is fortunate. Her private insurance covered the cost of today’s treatment – which could rise to $500,000 to $1 million. That’s because many patients experience acute side effects including severe flu-like symptoms and neurologic toxicities that require extended hospital stays, sometimes in the intensive care unit.

But Mary is facing the road ahead with nothing but optimism.

“There’s so many people out there that would love to have something like this. I have this amazing opportunity to live,” she said.

University of Chicago is the first cancer center locally to offer this breakthrough treatment.

To learn more about treatment centers offering the new non-Hodgkin lymphoma treatment, visit Yescarta's Website.

To learn more about treatment at University of Chicago Medicine, go to: