Payers cover off-label combinations only inside registry-randomised trials
Insurers already pay for many untested drug combinations. Paying only when the patient joins a simple randomised comparison would turn that spending into evidence.
Coverage with evidence development has been used by Medicare for devices and by NICE for cancer drugs through the Cancer Drugs Fund. Applying it to off-label combinations would fund a large pragmatic randomised programme with no new drug costs, since the drugs would be paid for anyway, and would end reimbursement of combinations that fail.
- Too many combinations to test · There are thousands of possible drug pairs and sequences. Trials can test a few dozen a year.
- 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
not linked directly; found by shared links- IdeaA registry of every treatment sequence patients actually receive, with outcomes
Shares Registry-embedded randomisation of treatment order in routine care, Too many combinations to test, Real-world evidence.
- IdeaA combination pricing rule so two-drug regimens are not priced as two monopolies
- IdeaPayers fund cancer drugs conditionally on a registry with a pre-specified analysis
Shares Real-world evidence, Prices and value.
- IdeaReassess cancer drug prices at three years using real-world outcomes
Shares Real-world evidence, Prices and value.
- IdeaWatch routine care for drug combinations that quietly make cancer treatment worse
- IdeaEmulate combination trials from real-world data to triage which ones to run
- IdeaA real-world sequencing analysis within a year of every new approval
- InstitutionScottish Medicines Consortium
Shares Real-world evidence, Prices and value.