Subscription pricing for checkpoint inhibitors: fixed national fee, unlimited use
Instead of paying per dose, a country would pay a fixed annual fee and treat every eligible patient with immunotherapy. This has worked for hepatitis C drugs and antibiotics.
Louisiana and Australia bought hepatitis C antivirals under subscription ('Netflix') models that delinked revenue from volume, and NHS England pays fixed annual subscriptions for two antibiotics. Checkpoint inhibitors are used across dozens of indications, are volume-limited in most middle-income countries by per-dose price, and have low marginal manufacturing cost. The proposal is a national subscription contract: a fixed annual payment for unlimited pembrolizumab or nivolumab (or a biosimilar once available) in all approved indications, with the manufacturer's incentive shifted to supporting diagnosis and appropriate use.
- 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.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.