Cencora Report Reveals Payer Trends Shaping Coverage for Cell and Gene Therapies
Conshohocken, Pa. (March 26, 2026) – Cencora, a global pharmaceutical and healthcare solutions company, today released Evolving Landscape of Payer Coverage for Cell and Gene Therapies (CGTs): Trends and Insights, a new report that examines how payers are approaching coverage decisions, utilization management, reimbursement and contracting for CGTs.
“As CGT clinical activity accelerates and developers increasingly target indications with larger patient populations, a well-defined market access strategy is critical to drive commercial success and enhance patient access,” said Louis Cicchini, Senior Director of Scientific Affairs and Strategic Partnerships for Cell & Gene Therapy at Cencora. “The insights from this report will help CGT developers anticipate payer expectations and align evidence and value demonstration plans with payer needs, better positioning them to navigate a complex environment and bring these therapies to the patients who need them.”
Based on findings from a survey of formulary decision-makers representing more than 154 million covered lives, the report offers insights across the product lifecycle to help developers strengthen access and reimbursement planning. Key findings include:
- Payers seek earlier engagement — but cite information gaps. Payers prefer to engage with CGT developers prior to FDA-approval, with the majority (58%) preferring engagement within six months of the anticipated approval. During early engagement, most payers cited limited clinical data availability (84%) and value/cost information (84%) as key barriers. By prioritizing early engagement, developers can better align with payers on budget impact, utilization management and contracting considerations.
- Strengthening the evidence story is critical to coverage decisions. When evaluating approved CGTs, 68% of respondents cited insufficient clinical efficacy evidence as a reason for denying or limiting coverage. Respondents also highlighted gaps in the communication of essential information, such as comparative effectiveness, downstream medical costs and duration of clinical response.
- Anticipate speed and scrutiny in coverage determination. Most payers (90%) determine coverage for traditionally approved CGTs within six months of FDA approval and use a variety of utilization management tools to manage access. Nearly three-fourths (74%) of respondents say they use prior authorization that is more restrictive than the label.
- Coding and reimbursement readiness remains critical. Reimbursement challenges are driven by uncertainty about long-term efficacy and safety (79%) and high upfront costs (74%). More than half (58%) said they are moderately-to-extremely likely to cover CGTs billed under miscellaneous codes, while respondents were split on whether unique reimbursement codes accelerate coverage and claims adjudication.
“Our research reinforces that access success for CGTs requires earlier, more-structured payer engagement and launch readiness,” said Kim Riggs, Vice President, Value, Evidence and Access at Cencora. “Developers that pair a clear value narrative with practical execution — including evidence that connects surrogate endpoints to the long-term outcomes payers prioritize — will be better positioned to achieve sustainable coverage and patient access.”
Cencora is hosting a virtual event, “Cell and gene therapies – U.S. payer trends,” on April 2, where experts will discuss key findings from the research and how CGT developers can optimize early payer engagement and define relevant evidence packages.
A leader in specialty pharmaceutical distribution and services, Cencora offers CGT developers support across the product lifecycle. For more information about Cencora’s capabilities, visit: https://www.cencora.com/specialties/cell-and-gene-therapy
About Cencora
Cencora is a leading global pharmaceutical solutions organization centered on improving the lives of people and animals around the world. We partner with pharmaceutical innovators across the value chain to facilitate and optimize market access to therapies. Care providers depend on us for the secure, reliable delivery of pharmaceuticals, healthcare products, and solutions. Our 51,000+ worldwide team members contribute to positive health outcomes through the power of our purpose: We are united in our responsibility to create healthier futures. Cencora is ranked #10 on the Fortune 500 and #18 on the Global Fortune 500 with more than $300 billion in annual revenue.