# Pay-for-cure contracts: instalment payments for curative therapies contingent on durable remission

Source: https://onco.cc/ideas/idea-moon-pay-for-cure-contracts/  
OnCo record `idea-moon-pay-for-cure-contracts` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

For very expensive one-time treatments such as CAR-T, pay in instalments over years and stop paying if the cancer comes back, so price tracks the cure actually delivered.

## Summary

One-time curative-intent therapies (CAR-T, gene therapies, potentially in vivo cell therapy) carry prices that health systems struggle to absorb up front and that are not tied to durability. Outcome-based agreements exist in a few countries. The proposal is a standard contract framework: payments spread over five years, annual instalments contingent on registry-verified remission, portability across payers when patients move, and public reporting of durability, with the same framework offered in middle-income countries at tiered prices.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Pay-for-cure contracts increase the number of patients treated with curative therapies by a third at the same budget and shift manufacturer investment toward durability of response.
- Rationale: Aligning payment with the outcome that matters removes the payer's risk on unproven durability and rewards manufacturers for cures rather than infusions.
- Proposed test: Implement for CAR-T in two national payers; compare patients treated, budget impact and durability data quality against payers using up-front payment.
- Maturity: early-clinical
- Actor: payer

## Sources

- Bottleneck evidence (Prices and value): Prasad, De Jesús & Mailankody, The high price of anticancer drugs: origins, implications, barriers, solutions (Nat Rev Clin Oncol 2017): https://doi.org/10.1038/nrclinonc.2017.31

## Connected records

- technologies: [CAR-T cell therapy](https://onco.cc/technologies/car-t/)
- drugs: [Axicabtagene ciloleucel](https://onco.cc/drugs/axicabtagene-ciloleucel/), [Ciltacabtagene autoleucel](https://onco.cc/drugs/ciltacabtagene-autoleucel/)
- 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/)
- key papers: [The high price of anticancer drugs: origins, implications, barriers, solutions](https://onco.cc/key-papers/paper-prasad-nat-rev-clin-oncol/)

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