Community oncology practices plan cellular therapy expansion despite access barriers

A new Community Oncology Alliance survey finds independent oncology practices are preparing to offer more cellular therapies, including outpatient CAR T, in 2026 and 2027 even as insurance coverage, upfront costs and reimbursement issues slow adoption. The findings highlight how community practices are trying to bring complex cancer care closer to home while needing new financial and operational support.

Why it matters: - Independent community oncology practices are trying to expand access to complex cancer treatments close to home. - The survey points to a gap between clinical ambition and the coverage, reimbursement and operational support needed to sustain those programs. - The findings matter for patients who may otherwise need to travel to larger centers for cellular therapy.

What happened: - The Community Oncology Alliance released its 2026 COA Cellular Therapy Survey on October 28, 2026. - Forty percent of respondents said they are currently offering or planning to offer cellular therapies to eligible patients in 2026 or 2027. - Respondents described plans to launch outpatient CAR T programs. - Practices said they are working with apheresis partners to collect cells and hospital partners to manage adverse events after infusion if needed.

The details: - The most frequently reported barriers to starting or maintaining a cellular therapy program were inconsistent insurance coverage at 54 percent and upfront program costs at 52 percent. - Other reported barriers included time-intensive single-case agreements with insurers at 44 percent, accreditation requirements at 40 percent, and after-hours and weekend patient monitoring at 38 percent. - About 76 percent of respondents selected fair product coverage and reimbursement as the support that would help them build or maintain a program. - Seventy-one percent selected reimbursement for patient navigation and monitoring. - Respondents also asked for financial planning tools, peer learning opportunities from other community practices, and guidance on hospital and apheresis partnerships. - The survey found that 91.4 percent of 93 respondents in COA’s recent bispecific therapy survey already administer bispecific therapies in-office. - Bispecific therapies are designed to bind to two targets at once, with some bringing immune cells and cancer cells together to help the immune system attack cancer.

Between the lines: - The survey suggests community oncology practices are not pulling back from advanced therapies; they are trying to build the infrastructure to deliver them locally. - Coverage policy appears to be a central lever for whether cellular therapy expansion is practical outside major academic centers. - COA is using the survey results to argue that support for independent practices could widen access to innovation without forcing patients to travel as far for care. - Christine Pfaff, COA’s director of clinical initiatives, said the findings show a clear opportunity to support independent community oncology practices with workable coverage policies and the resources needed to deliver complex treatments.

What’s next: - Practices that want to expand cellular therapy will likely need to secure payer coverage, financing and partner arrangements before launch. - The survey points to continued pressure on community oncology groups to build outpatient capabilities for CAR T and related treatments. - COA will likely continue using survey data to press for reimbursement and operational policies that support community-based delivery of advanced cancer care.

The bottom line: - Community oncology practices are moving toward more advanced cancer care, but insurance, cost and staffing hurdles remain the main constraints on how fast they can expand.