I was hiking in Vail, Colorado, mid-climb on a switchback, huffing and puffing, when my phone rang. It was Karin Donaldson, my TIL coordinator for the better part of the last decade. “Great news,” she said. “We connected with Cigna, and they want to do a peer-to-peer.” I asked when. “Probably now.”
Within seconds, I heard the call-waiting beep. That’s probably them, I thought, and switched over.
The subject: a young patient with melanoma who wasn’t responding to frontline immunotherapy. We’d been working through the options for weeks — palliative resection versus tumor-infiltrating lymphocyte (TIL) therapy. TIL was clearly the better path if we could get there. The obstacle, as it so often is, was insurance.
On the other end was a BMT physician reviewer who, it turned out, already knew my track record — a decade of TIL work. We spent 20-30 minutes walking through the clinical picture and the urgency, me still catching my breath the entire time. I’ve joked with colleagues since that he probably assumed I’d sprinted to the phone, mid-shift, somewhere in a hospital hallway — not that I was gasping my way up a Colorado mountain on vacation. By the end of the call, he didn’t need to push a full approval through committee. He authorized the benefit verification on the spot — enough to move the patient into tissue procurement under the manufacturer’s bridging program, which allows harvest and manufacturing to begin while the formal insurance process runs in parallel, holding the product for up to 12 months.
That one decision unlocked everything downstream: procurement, manufacturing, and a real shot at BRAF-directed therapy plus TIL on the back end for a patient who, a few weeks earlier, wasn’t sure this was going to happen at all.
I’ve heard from colleagues at other centers who’ve hit real friction getting TIL therapy approved through this payer. So I want to be clear about what actually happened here, because it’s worth naming: a payer reviewer engaged seriously with the clinical urgency, a manufacturer built a bridge program flexible enough to accommodate exactly this kind of timing gap, and our own cell therapy team at AdventHealth Cancer Institute moved fast enough to make use of both. Three organizations, three different sets of incentives, one patient’s outcome as the shared priority.
It’s easy — and often fair — to be skeptical of insurers and manufacturers in oncology. Prior authorization delays cost real time, and time is the one thing our patients with aggressive disease don’t have extra of. But this case is a reminder that the system can work when the people inside it choose to make it work. That’s true of the reviewer who picked up the clinical urgency instead of defaulting to process, and it’s true of a manufacturer access program designed with enough flexibility to meet patients where the insurance timeline can’t.
Our patient is scheduled for tissue procurement this coming week. If things go as planned, she’ll have a TIL product manufactured and waiting while we optimize her disease control — genuinely one of the better-case scenarios I could have hoped for when we started this conversation a few weeks ago.
I want to name the three organizations that made this possible, because credit is due. AdventHealth Cancer Institute’s cell therapy team moved fast enough to act the moment the door opened. Iovance’s manufacturing facility built a bridge program with enough flexibility to hold a product for a patient still working through insurance. And Cigna’s reviewer engaged with real clinical urgency instead of defaulting to process. None of that was guaranteed, and none of it happens without all three choosing to show up.
Sometimes the best stories in oncology aren’t about a new drug or a new trial. They’re about three organizations choosing to be flexible at exactly the right moment for exactly the right patient.
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. He brings a wealth of expertise to the complex and challenging world of oncology.
Disclosures:
Dr. Thomas serves as a speaker for BMS, Merck, Ipsen, Natera, Immunocore, Pfizer, Sun Pharma, SpringWorks. He also receives industry grants in support of numerous clinical trials.
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