BOSTON – When Novartis AG's Kymriah (tisagenlecleucel) became the first CAR T therapy on the market after winning FDA approval last year for B-cell precursor acute lymphoblastic leukemia (ALL), the $475,000 price tag was mitigated somewhat by news that the Swiss pharma offered an outcome-based plan in which treatment would be reimbursed only when patients responded to therapy at the end of the first month. While the move ramped up discussions on how to shift the U.S. health care economics from volume-based pricing to a value-based or outcomes-based model – a change that will become increasingly necessary as more life-changing and potentially curative gene and cell therapies reach market – cost alone marks only one of the challenges in getting CAR T treatments to patients.