# Subscription pricing for checkpoint inhibitors: fixed national fee, unlimited use

Source: https://onco.cc/ideas/idea-reg-io-subscription-national/  
OnCo record `idea-reg-io-subscription-national` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: In a subscribing middle-income country the number of patients treated with checkpoint inhibitors rises at least threefold at total spend no higher than the prior year, and the manufacturer's revenue is maintained or increased.
- Rationale: Where the marginal cost of production is low and the untreated population is large, both parties gain from delinking price from volume; subscription also removes the rationing by indication that per-dose pricing forces.
- Proposed test: Negotiate a three-year subscription in one or two middle-income countries and compare treated patients, spend and outcomes with matched countries on per-dose pricing.
- 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: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- drugs: [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [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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