Cell therapy products have rapidly evolved from discovery and early phase trials into commercial products with evidently limited process development, such that we are now deploying technologies with cost of goods which are orders of magnitude higher than comparable biologics. In parallel these technologies are being introduced into reimbursed markets where the clinical and commercial obligations place unprecedented demands upon all the stakeholders, including healthcare providers, jurisdictions and reimbursement bodies. Manufacturing including process evolution and development, incoming apheresis product control, cold chain logistics and downstream processes will be discussed, contrasting the different strategies that are now being applied to reduce frequency of out of specification products and manufacturing failures. The cost of these technologies, whilst high, represent the current level of process control, and our lack of certainty on the causes of manufacturing failure. Future models of process optimisation will be presented to consider how we can control these production variables and reduce cost. The significant differences in CAR-T deployment and funding will also be discussed, as well as the very real threats to equitable product availability if the best delivery frameworks are not put into place, with optimal jurisdictional oversight.