Pay-for-cure contracts: instalment payments for curative therapies contingent on durable remission
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.
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.
- 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.
- Incentives reward me-too drugs and marginal gains · The system pays the same for a drug that adds two months as for a cure, so companies race to copy rather than to cure.
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