In our previous installment, we examined how Authorized Treatment Center (ATC) activation and site readiness can make or break a cell / gene therapy (CGT) launch. In this post, we address a challenge that sits just upstream: ensuring that eligible patients actually make it to those ATCs in the first place. Even a perfectly prepared treatment network delivers little value if the referral pathway feeding it is leaky, slow, or poorly defined. 

The CGT referral pathway is rarely direct. In our experience, it is almost always more complex than manufacturers initially expect. 

A Journey Full of Handoffs

In many CGT indications, a patient’s path to treatment begins far from an ATC. It might start with a primary care physician noticing a symptom, progress to a community specialist for disease confirmation, involve one or more additional consultations for genetic counseling or biomarker testing, and only then reach a specialist capable of evaluating CGT eligibility and initiating a referral. The sequence may vary, but each handoff along this chain introduces a risk of delay, fatigue, or outright abandonment. 

This complexity is compounded in Rare Diseases, where the diagnosing physician may have limited familiarity with CGT as a treatment option, may have never referred a patient to an ATC, and may not even know which centers in their region are authorized to administer therapy. In these situations, clinical awareness of a therapy’s existence is necessary, but nowhere near sufficient. The practical mechanics of referring a patient (e.g., who to contact, when to contact, what information to provide, what to tell the patient about next steps) must be as frictionless as possible to preserve patient flow. 

Why Referring Physicians Hesitate

Understanding why referrals stall is as important as understanding the structural pathway itself. In our experience working across CGT commercialization engagements, physician hesitancy rarely stems from a single cause. More often, it reflects a combination of interconnected concerns: 

  • Uncertainty about patient eligibility – Eligibility criteria for CGTs can be complex, involving specific biomarker profiles, prior treatment history, age windows, or performance status thresholds. Physicians who are unsure whether their patient qualifies may default to watchful waiting rather than risk an unsuccessful referral that disrupts the patient relationship. 
  • Financial and administrative apprehension – Referring a patient for a high-cost, one-time therapy can trigger concerns about what that process will mean for the patient financially, and for the physician administratively. Without clear guidance, these concerns become barriers. 
  • Fear of losing the care relationship – Community physicians and specialists often have deep, longitudinal relationships with their patients. The prospect of transferring care to a distant ATC (even temporarily) can feel like a disruption to a relationship the physician values and the patient depend on. In some markets, there may also be practice economics considerations which can muddy the waters. Without clarity about what return-to-community care looks like after treatment, this concern can quietly suppress referral behavior. 
  • Lack of a clear “how” – Perhaps most practically, many physicians simply don’t know how to initiate a referral. Who do they call? When do they call? What information does the ATC need? How quickly will the patient be seen? When the process feels opaque, inaction becomes the path of least resistance. 

It’s important for manufacturers to take the challenge of inertia seriously.  Often, it’s a more formidable issue than manufacturers estimate, particularly in disease areas where there is no near-term morbidity risk.  

Shaping the Pathway Proactively

The manufacturers best positioned to preserve patient momentum are those that address referral pathway shaping as a deliberate commercial and medical priority. It can’t simply be addressed by a brochure and a phone number. 

This begins with genuine pathway mapping. Before launch, companies should invest in truly understanding how patients currently move through the system in their specific indication: which specialists see the patient at each stage, where the longest delays occur, and which friction points are most amenable to intervention. Real-world pathway data, combined with qualitative research with referring physicians and ATC specialists, can surface insights that are invisible from clinical trial experience alone. Then, they need to consider the optimal state for patient movement to support therapy uptake and improved care. 

From there, interventions should be targeted and practical. Peer mentoring programs that connect community physicians with ATC-based specialists have proven particularly effective in building referral confidence. Hearing from a trusted clinical peer that the process is manageable, and that patients return to community care after treatment, can shift behavior in ways that promotional materials simply can’t. Concierge referral hubs that provide a single point of contact for initiating and tracking referrals reduce administrative burden and signal to referring physicians that their patients will be well-supported. Return-to-community care toolkits, which provide clear documentation of what ongoing monitoring looks like post-infusion and what role the referring physician will play, directly address the relationship continuity concern that often goes unspoken. Of course, these “next level” interventions and resources should build on a foundation that includes clear and accessible information on topics such as patient eligibility criteria and which centers are authorized to administer a given CGT. 

Importantly, a manufacturer should design referral support with the referring physician’s workflow in mind, not its own commercial objectives. Physicians who feel that the whole referral process has been made genuinely easier for them and their patients become consistent referral sources. Those who feel they are being managed become obstacles. 

The Bottom Line

A well-activated ATC network and a well-educated market create the conditions for referrals to happen. But those conditions alone are not enough. CGT manufacturers that systematically map their referral pathways, understand when, where and why momentum is lost, and invest in practical tools to address those barriers are the ones that translate clinical demand into consistent patient flow. 

Next in the series: Success Factor 4 – Planning for a Challenging Reimbursement Process.