Outcome-based annuity payments for potentially curative one-time therapies
Instead of paying hundreds of thousands up front for a CAR-T or gene therapy, the health system would pay in yearly instalments that stop if the cancer comes back, so companies are paid for cures, not attempts.
Outcome-based annuities, already used for some gene therapies (for example spinal muscular atrophy and haemophilia contracts in Europe), applied systematically to cell therapies, bispecifics with curative potential and future one-time oncology treatments: payment spread over five years, each instalment contingent on the patient remaining in remission by pre-agreed criteria (imaging, MRD negativity). Payers gain risk-sharing; manufacturers gain higher total payment for real cures and a strong incentive to select patients well and improve durability. Needs a registry to adjudicate outcomes and accounting rules that let payers commit across years.
- 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.
- 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.
Pages like this
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