Expanding Cell and Gene Therapy Adoption in Oncology Care

Key Takeaways:

• McKesson’s recent Cell and Gene Therapy Report characterizes the increasing adoption of cell and gene therapies (CGTs) among oncology physicians as well as the evolution in CGT pipelines.
• Complex referral procedures and patient travel burden remain significant barriers to CGT utilization, particularly for chimeric antigen receptor (CAR) T-cell therapy.
• Evolving reimbursement strategies and implementation of artificial intelligence (AI) tools may reduce access barriers and improve CGT utilization among cancer patients.

In this interview, Joe DePinto, head of Cell, Gene & Advanced Therapies at McKesson, discusses the results from the 2026 Cell and Gene Therapy Report, focusing on the expanding adoption of CGT in oncology care. He explores the potential role of AI in optimizing patient care, as well as how reimbursement reform can reduce barriers and increase utilization of CGT.

Joe DePinto: My name is Joe DePinto, and I’m the head of Cell, Gene & Advanced Therapies at McKesson. I currently lead our cell- and gene-dedicated business vertical called InspiroGene. I've been in the health care industry for over 30 years and spent most of my career helping to bring life-saving specialty drugs to market. I am drawn to the science and helping patients get access to these groundbreaking therapies.

With the average number of patients oncologists treat with CGTs nearly doubling since 2024, how should oncology clinical pathways evolve to accommodate growing adoption?

DePinto: Clinical pathways should reflect the differences between CGTs as they continue to become more routine in commercial patients. Cell therapies act differently than gene therapies, which should be taken into consideration when looking at pathways.

It's exciting to see the evolution from the physician primary research year over year. In our recent CGT report, the average number of patients nearly doubled, going from 17 patients in 2024 to 32 in 2026, which speaks to the commercial adoption of these products. A survey of oncology physicians showed that an increasing number believe in the promise of CGTs and the efficacy of these products, as 97% of the oncologists surveyed believe CGT is the best chance for cure.

The positives of the survey demonstrated an increasing adoption of CAR T therapies along with an evolution of CGT pipelines. In a pipeline of 568 late-stage therapeutics, more of these products are being used in larger patient populations and moving up in lines of therapy in the oncology space.

It is important to take that into consideration when thinking about clinical pathways in this space. Overall, there are many positives to report, and progress has been made year over year. The beauty of these reports being done for 3 consecutive years is their ability to help track adoption.

Despite increasing adoption, many eligible patients still do not receive CAR T therapy. What are the most significant barriers to access, and how can clinical pathways help address them?

DePinto: It’s well documented that approximately 2 out of 10 eligible patients receive CAR T therapy. Numbers drop off due to a variety of issues, such as the referral process. The recent CGT report with oncology physicians saw only a slight increase in physician referrals. The referral process is even more complicated when patients are referred from a community practice to an academic center, where a significant drop off was observed.

Other access barriers relate to reimbursement or insurance coverage. Some caregivers support others. Travel requirements, including how long a patient travels to get care and how long they stay at that geographic area during therapy, all play into the referral process, which is why many patients fail to get access to CAR T.

Pathways can be helpful in identifying the best eligible patients for CAR T and planning for caregivers, site availability, and coverage from an insurance standpoint

As payers move toward standardized case rates for cell therapies, how might these reimbursement changes influence treatment decisions and clinical pathway development?

DePinto: The recent CGT report published several weeks ago found interesting data on the evolution of payment, showing cell therapy movement from single case rates to contracted rates, which is a big plus. In Medicare Advantage, payers estimate that around 79% of CAR T claims go through a contracted rate. On the gene therapy side, roughly 75% of therapies still receive their payment through a single case rate agreement.

As reimbursement becomes more standardized and predictable under contract rates, more patients are able to access products in a more efficient manner.

Payers stated that prior authorizations (PAs) are critical to ensure that the right patient gets the right drug. Payers also talk about increased efficiency of cell therapies through the PA process, taking a shorter amount of time on the gene therapy side. Ultimately, when we polled some of our thought leaders on the payer side around PA, the goal of PA is to get to “yes,” not “no.” Making sure the right information is provided during PA procedures is an important component of navigating the reimbursement process. Moving cell therapy from single case rate to contracted rate is a step in the right direction.

How can AI improve CAR T patient identification, referrals, and treatment coordination, particularly within community oncology practices?

DePinto: Over the summer, we hosted a roundtable on how AI can help deal with the complexity of the value chain in CGT. There was a strong focus among the participants, both CGT experts and AI experts, on how AI can be a force multiplier in efficiency.

First, AI helps to identify patients more efficiently. It helps to manage the complexity of a fragmented referral process, including how patients get rooted to the ideal treatment center, travel distances, and optimized care. How can AI help optimize reimbursement through PA processes and coverage policies?

CGTs are often given at authorized treatment centers. How can AI help biopharma authorize treatment centers more efficiently by streamlining fragmented processes?

With the complexities of navigating the value chain, using AI as a resource could be an interesting use case that needs to be examined by the entirety of the cell engine ecosystem, not just a single component. Because of its complexity and vastness, AI can bring an overarching approach to patient access.

The round table was great, and I was pleased with the outcome. Hopefully the readers of the report will find some interesting pearls to take away as they think about the use of AI in CGT.

With oncologists expecting CGT care to remain centralized, how can clinical pathways support greater collaboration between community oncology practices and specialized treatment centers as these therapies expand?

DePinto: It's interesting to see the viewpoint of therapeutic specialists around centralized vs decentralization of care for CGT. Approximately two thirds (65%) of oncologists expected CGT to remain centralized. The report also included rheumatologists, who treat the emerging autoimmune area, and ophthalmologists who use gene therapy in the retina space. Approximately 64% of the rheumatologists and 62% of the ophthalmologists believed CGTs would become more decentralized.

This is going to be interesting to watch evolve over time because CGT has a lot of experience in the oncology area along with an emerging market in rheumatology and ophthalmology. What commonalities develop and how the referral process works will evolve as those emerging areas move from clinical trials to commercial use. Clinical pathways can streamline when referral happens, how it is handled, and how to optimize centralization vs decentralization of treatment of these patients. Clinical pathways will continue to evolve in this space as the market continues to evolve.

Are there any final thoughts you’d like to add?

DePinto: I'm excited about the publication of the report. This is our third year in doing it, and we've seen significant progress in some areas, and there is still work to do in adopting CGTs commercially. What I like about the report this year is that it is anchored around primary research with oncologists and expands payer research.

This year's report focuses on solutions like AI to solve the complexity of the value chain. And every year included thought leaders from around the country discussing practical real-world experience in treating patients. This year included thought leaders from major academic centers like City Oak, University of Kansas, and the University of Colorado as well as community practices like Florida Cancer Specialist. This year added a new component, which is patient cases and perspectives: a cell therapy patient perspective and a gene therapy patient perspective. These thought leaders dealt with the challenges of commercially navigating the value chain.

I hope that readers find the report to be a resource they can use as a practical tool to help assist patient navigation of commercial access to this groundbreaking science of CGT.