ideasIdea
Reassess cancer drug prices at three years using real-world outcomes
Set the price of a new cancer drug provisionally, then adjust it up or down after three years depending on how well patients actually did.
Prices are set at approval on trial data and rarely revisited. Outcome-based agreements exist but are bespoke and opaque. The proposal is a standard pricing rule: initial price tied to trial evidence, mandatory structured outcome capture, and a scheduled reassessment at three years using pre-specified real-world survival and toxicity metrics, with published adjustment formulae. Italy's AIFA registries and Germany's AMNOG reassessments are partial precedents.
Hypothesis
Scheduled reassessment will lower prices for drugs whose real-world benefit falls short of trial results and will make outcome capture near-complete because payment depends on it.
Rationale
Payment tied to data has been the only reliable driver of completeness (see SACT); tying price to outcome aligns the incentive to collect with the incentive to deliver value.
What would test it
Apply the rule to ten new indications in one national payer; report data completeness and the direction and size of price adjustments at reassessment.
Maturity
early clinical
Who has to act
payer
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks
- Weak real-world evidence and registries · We do not reliably know what happens to patients after approval, so we cannot tell which drugs deliver in practice.
- Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
- Incentives reward me-too drugs and marginal gains · The system pays the same for a drug that adds two months as for a cure, so companies race to copy rather than to cure.