ideasIdea
A delinked market-entry reward paid by payers when a repurposed generic wins approval
Instead of letting a company charge more for a newly proven use of an old drug, payers would pay a one-off reward and keep the price low for everyone.
Delinked rewards separate the return on R&D from the price of the product; they have been proposed and partly implemented for antibiotics (UK subscription, PASTEUR Act proposals). For repurposing, the proposal is a pre-announced reward (for example $30-100 million depending on the size of benefit) paid by a consortium of payers to the sponsor of a positive registration-quality trial of an off-patent drug in cancer, conditional on the label being updated and the price remaining at generic levels. Payers benefit because the drug remains cheap while the incentive to run the trial exists.
Hypothesis
A published reward schedule induces at least five registration-quality repurposing trials within five years and delivers proven indications at generic prices, saving payers more than the rewards paid.
Rationale
Where the product is already cheap, the efficient way to fund evidence is to pay for the evidence directly rather than through monopoly pricing; the reward can be tied to the magnitude of benefit shown.
What would test it
Have three or four national payers commit to a reward pool and announce criteria; track trial registrations, completions and label updates over five years.
Maturity
speculative
Who has to act
payer
Cost to try
Large (over $50M)
Years to first evidence
5
Bottlenecks it attacks
- No incentive to repurpose cheap drugs · Old, cheap drugs with anti-cancer signals never get the trials they need because no one profits from the result.
- 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.