AP-003

Pediatric leukemia, rural, Medicaid, over 150 miles

CAR-T · Phase 2, Candidacy Evaluation · 26 days in stage · 17 barriers, 6 blocking

Falling behind26 days in work-up to candidacy decision, past the 21-day target

Follow one barrier

Diagnosis & Referral

From diagnosis to first contact with an accredited center.

Any order, all required

Start ahead · work beginning here for later phases

Start the single-case agreement / out-of-state enrollment as early as possible · Single-case agreement / out-of-network · for phase 3
Confirm the center’s caregiver requirement and any flexibility · Caregiver & psychosocial clearance · for phase 2
Start caregiver planning now; explore paid-caregiver and respite options · Caregiver & psychosocial clearance · for phase 2
Connect family to caregiver stipend / paid-leave resources and advocacy · Caregiver & psychosocial clearance · for phase 2
Enroll in manufacturer assistance / copay programs · Financial toxicity / out-of-pocket burden · for phase 2
Arrange professional interpreters and language-concordant materials · Language & communication barrier · for phase 2
Secure subsidized / free housing near the center early · Housing insecurity / relocation burden · for phase 2
Plan bridging early with a standardized protocol; avoid bendamustine before apheresis · Manufacturing / collection & vein-to-vein risk · for phase 4
Arrange non-emergency medical transport (NEMT) and confirm coverage · Transportation barrier · for phase 2

The work-up that determines whether the center will proceed. Most tests run in parallel and all feed the selection decision.

Any order, all required

Start ahead · work beginning here for later phases

Secure authorization before apheresis to avoid a stalled start · Single-case agreement / out-of-network · for phase 3
Verify benefits and secure prior authorization before apheresis · Insurance coverage & prior-authorization · for phase 3
Ask about early leukapheresis + cryopreservation to protect T-cell fitness · Manufacturing / collection & vein-to-vein risk · for phase 4

Securing payer approval and financial clearance for the specific therapy.

Any order, all required

Obtaining the cells and getting the patient ready. This is where CAR-T and allogeneic transplant diverge.

CAR-T track

Shared preparation — in parallel with collection

Any order, all required

Conditioning, infusion, and the acute monitoring window.

Monitoring, transition back home, and long-term survivorship.