One Price in Japan, Response-Linked Payments in Australia and No Public Price in China: In Asia-Pacific the Payer Sets the CAR-T Price

Across Asia-Pacific, the payer decides what a CAR-T therapy costs. Japan prices each new product off the first one, Australia, Taiwan and Singapore attach conditions to public money, and China and India have no public payer for CAR-T at all, which is where products built at home are winning. A company launching CAR-T in the region is entering three markets with three different questions.

Japan prices every new CAR-T against Kymriah, so the price does not move between products

Japan lists CAR-T products as regenerative medicine products under national health insurance. When Breyanzi came up for listing in May 2021, the health ministry priced it by the similar-efficacy comparison method with Kymriah as the comparator, calculated ¥34,113,655 per patient and granted no usefulness premium. Yescarta, listed in April 2021, was calculated at the same figure and listed at ¥32,647,761 after an adjustment that followed Kymriah’s cost-effectiveness evaluation.

Each new entrant inherits a single reference price. A sponsor cannot launch below it to win share, and it cannot argue its way above it without a premium the ministry did not grant Breyanzi. Breyanzi did qualify for the premium that protects new drugs from routine price cuts, which preserves the price rather than raising it.

That makes Japan the region’s most predictable CAR-T market and its least flexible one. The contest moves to how many indications a product carries, how early in treatment it is used and how many centres can give it.

Outside Japan, the region divides by who holds the budget. Exhibit 1 sets out the seven markets with approved CAR-T products by payer, price signal and the condition attached to public or private money.

Australia and Taiwan pay from public budgets and make the sponsor carry part of the risk

The middle rows of Exhibit 1 are where the region’s access terms are being written. MSAC supported public funding of Carvykti for adults with myeloma after at least four prior lines, through the National Health Reform Agreement’s route for highly specialised therapies. Its April 2024 model paid for the product in stages, shown in Exhibit 2.

The schedule moves four of the five payments into the years after infusion, where each depends on durable response. In November 2024 MSAC said the four-year scheme fitted the evidence best, rejected the company’s proposed patient cap and advised that patients treated above the estimate should attract only a reduced one-off payment. The funded terms are not public; the health minister said only that the therapy is free to eligible patients and would otherwise cost each patient more than $200,000 a year.

Taiwan controls volume through delivery rules instead. Its National Health Insurance has covered Kymriah since 1 November 2023 for patients aged 25 or under with B-cell acute lymphoblastic leukaemia and adults with large B-cell lymphoma after two lines, once per lifetime, after expert panel review, at hospitals that average at least 20 stem cell transplants a year and must hold AABB or FACT-JACIE accreditation for cell collection by 2029. Singapore caps the insurer’s share: MediShield Life pays up to S$141,000 per treatment for Kymriah and Yescarta from June 2026, outside the policy-year claim limit.

China put five CAR-Ts on a list that basic insurance will not pay for

China’s National Healthcare Security Administration and the human resources ministry published the first commercial health insurance innovative drug list on 7 December 2025, with 19 drugs valid from 1 January 2026 to the end of 2027. Five are CAR-Ts: axicabtagene ciloleucel from Fosun Kite, relmacabtagene autoleucel from JW Therapeutics, equecabtagene autoleucel, zevorcabtagene autoleucel and inaticabtagene autoleucel.

The notice says these drugs are not paid from basic medical insurance funds and do not count against hospitals’ self-pay ratios, and it encourages commercial insurers to build products around the list. It publishes no prices. CAR-T gains a route into hospitals and insurance products in China without a public price that other payers could reference.

Three of the five were invented in China. Axi-cel reached China through Fosun Kite, the joint venture with Gilead’s Kite, and JW built relma-cel on a CAR-T platform licensed from Juno, a Bristol Myers Squibb company. The multinational route into China’s CAR-T market runs through a Chinese manufacturer.

China is also first to a solid tumour. The National Medical Products Administration approved CARsgen’s satricabtagene autoleucel on 22 June for Claudin18.2-positive, HER2-negative gastric or gastro-oesophageal junction adenocarcinoma after at least two prior lines, which CARsgen calls the first CAR-T approval for a solid tumour anywhere.

India and Korea show what a domestic CAR-T does to the reference price

India approved its first CAR-T, ImmunoACT’s NexCAR19, in October 2023, developed at IIT Bombay and tested at Tata Memorial Centre. The US National Cancer Institute, which collaborated on early work, put its expected cost at about $50,000 against about $400,000 for a CAR-T infusion in the US. ImmunoACT now offers interest-free instalments of up to ₹10 lakh and a value-based offer of the same size, both aimed at patients who pay for treatment themselves.

Korea is the clearest test of what comes next. Curocell’s Rimqarto (anbalcabtagene autoleucel) won full approval from the Ministry of Food and Drug Safety on 29 April for large B-cell lymphoma after two or more lines, with a 67.1% complete response rate in its Phase 2 trial, and was placed in the health ministry’s pilot that runs approval, evaluation and price negotiation together. Korea already reimburses Kymriah in the same setting, so a domestic product priced for the national insurer will sit beside an imported one.

Each domestic entry resets the comparison a payer makes. An insurer that can buy a locally made CAR-T will ask the imported one to justify the gap, and where there is no public payer, the patient makes that comparison directly.

Sponsors need a different plan for each of the three markets

Multinational CAR-T companies. Gilead’s Kite, Bristol Myers Squibb, Novartis and Johnson & Johnson with Legend face a fixed price in Japan, so the plan there is indication sequencing and centre capacity. In Australia, Taiwan and Singapore the plan needs a registry, a finance team that can wait up to four years for full payment, and a view on how many patients the payer expects.

Chinese developers. The commercial list gives them hospital access at home without a published price, which keeps their domestic price out of other countries’ reference sets. That matters when they license abroad, because a buyer’s payers have no Chinese price to point to.

Payers outside the region. Response-linked payment is spreading beyond Australia. Denmark’s Medicines Council recommended Tecartus on 2 October under an agreement in which the price depends on whether patients respond, after rejecting it in January.

What to watch

• Korea: Rimqarto’s negotiated price and listing date, the first domestic CAR-T price in a market that already pays for an imported one.
• China: whether satri-cel and other new CAR-Ts join the commercial list when it is next revised, and whether any CAR-T reaches the basic list.
• Australia: the registry outcomes behind Carvykti’s funded terms, which will show how much of the price is paid.
• Japan: any CAR-T listing that departs from the Kymriah comparator, which would be the first sign the single price is breaking.