# Reassess cancer drug prices at three years using real-world outcomes

Source: https://onco.cc/ideas/idea-data-outcome-based-price-reassessment/  
OnCo record `idea-data-outcome-based-price-reassessment` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: 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
- Actor: payer

## Sources

- Bottleneck evidence (Weak real-world evidence and registries): Gyawali, Hey & Kesselheim, Assessment of the clinical benefit of cancer drugs receiving accelerated approval (JAMA Intern Med 2019): https://doi.org/10.1001/jamainternmed.2019.0462

## Connected records

- ideas: [Payers fund cancer drugs conditionally on a registry with a pre-specified analysis](https://onco.cc/ideas/idea-data-coverage-with-evidence-development/)
- fronts: [AI & Computation](https://onco.cc/fronts/ai-computation/)
- terms: [Real-world evidence](https://onco.cc/terms/real-world-evidence/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/), [Weak real-world evidence and registries](https://onco.cc/bottlenecks/b-real-world-evidence/)
- key papers: [Assessment of the Clinical Benefit of Cancer Drugs Receiving Accelerated Approval](https://onco.cc/key-papers/paper-gyawali-jama-intern-med/)

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