OnCo
ideasIdea

A non-profit manufacturer for generic cancer drugs in chronic shortage

Cheap, essential chemotherapy drugs like cisplatin run out because making them is not profitable enough. A non-profit maker could guarantee supply at a fair price.

The 2023 US shortages of cisplatin and carboplatin, and recurrent shortages of methotrexate, vincristine and other generic oncology drugs, arise from thin margins, concentrated manufacturing and quality failures at single plants. Civica Rx, a non-profit founded by US health systems, has shown that a mission-driven manufacturer with long-term hospital contracts can stabilise supply of generic hospital injectables. The proposal is a non-profit oncology generics manufacturer or a Civica oncology division, with multi-year purchase commitments from health systems and dual-sourced active ingredients, initially for the ten most shortage-prone oncology injectables.

Hypothesis
Health systems contracting with the non-profit manufacturer experience at least 80% fewer shortage days for covered oncology drugs and pay prices within 20% of prevailing generic prices.
Rationale
Shortages are a market failure of under-investment in redundancy for low-margin products; a manufacturer whose objective is supply reliability rather than margin, backed by demand guarantees, corrects the incentive.
What would test it
Fund production of five shortage-prone oncology injectables with commitments from 50 hospitals and track shortage days and prices against national shortage data for three years.
Maturity
early clinical
Who has to act
philanthropy
Cost to try
Large (over $50M)
Years to first evidence
3
Bottlenecks it attacks
  • 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.

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