Innovative drugs like Kymirah deserve innovative reimbursement contracts – paying for value, not by the pill. Novartis is embracing that adage, and offering to waive the drug's $475,000 fee for patients who don't respond.
That's great, but we're not just paying for medicines. Bundled payments for all oncology-associated care (including hospital, ER costs, and physician visits) linked to patient outcomes can encourage providers and drug companies to collaborate — and compete— on delivering the best outcome for each patient as efficiently as possible.
Kymirah can make a great test case for this approach. Treatment centers that specialize in gene and cellular therapies can work with Novartis and other companies to build detailed patient registries that help oncologists use "real-world data" on what really happens to patients — and why — to improve outcomes while reducing unnecessary costs and avoidable side effects. We already take a similar approach with patient registries and bundled payments for organ transplants.
The bottom line: An outcomes-based payment system can help us put more patients' cancers into remission for longer periods of time – with fewer wasted treatments, and less need for follow on therapies. That's greater value for every dollar we spend on cancer care.
Other voices in the conversation:
- Greg Aune, pediatric oncologist, Greehey Children's Cancer Research Institute: Value isn't just about surviving cancer
- David Mitchell, president and founder, Patients for Affordable Drugs: Drugs don't work if people can't afford them
- Usman Azam, president & CEO, Tmunity Therapeutics: How to evaluate breakthrough therapies
- Austin Frakt, health economist, Department of Veterans Affairs, Boston University and Harvard University: The public should have a say in what a drug is worth