No Cure, No Pay
Emile Voest, an oncologist in the Netherlands, conceived the idea of a no cure, no pay model. After witnessing the exorbitant cost of drugs, some of which pharmaceutical companies didn’t even know for sure would help patients, he knew something had to be done. He says the model is a stepping stone, not a final solution. But hopefully, this new model will allow more patients to access novel therapies which have the potential to serve their needs.
Essentially, patients will only pay for certain drugs if they are documented as effective by week 16 of treatment. If the drug is not effective, the drug companies will not be paid.
This project has been possible due to collaboration of the Netherlands Care Institute, oncologists, Bristol-Myers Squibb (paying for the project), as well as health insurers.
To test its potential, experiments are being conducted across the country.
It is expected that if this model shows success, the European Union will work to spread its implementation throughout every member state.
These experiments are referred to as the DRUP studies. They are being conducted at 30 hospitals across the Netherlands. These studies aim to evaluate whether or not drugs created for certain cancers could aid patients with other cancer types as well. Many of these drugs have not been studied in smaller patient populations due to the challenge of conducting the size trial that would be necessary to ensure effectiveness.
For instance, one study evaluated the effect of nivolumab on MSI-H tumors, urothelial carcinoma, non-small cell lung cancer, renal cell carcinoma, and others. 2/3rds of the MSI-H tumor patients responded to the therapy. Now, that evaluation is being continued with 135 MSI-H tumor patients for a period of 16 weeks. The drug company Bristol-Myers Squibb will be reimbursed for the treatment of every patient who experiences either tumor shrinkage or no progression of disease.
As the field of personalized medicine grows, this new model is ensuring that price tags also become personalized.
The fact of the matter is “every patient is unique, every tumor is different, every DNA profile has its own peculiarities.”
Unfortunately, progress in chronic and rare diseases can often not be measured easily. While you can measure the growth or decline of a cancer patient’s tumors, it can be difficult to set universal criteria for other illnesses. What qualifies as a drug “working” for a patient? How is progress measured?
Due to the small patient populations for these illnesses, it can also be hard to predict before the drug is administered what the response rate will be.
Besides these issues, this model is also imperfect because it doesn’t specifically address the high cost of drugs. Essentially, it only controls when these high costs are paid. In fact, it may even help maintain these high costs for pharmaceutical companies because the model gives them proof that their medicines work for a specific population. If they can offer this “guarantee”, it is easier for them to justify a higher cost.
For this reason, some people are against the model. For cystic fibrosis (CF), the Netherlands tried a system where the more frequently a drug was prescribed, the higher the discount provided. In this way, the government could know in advance their costs and didn’t have to wait for patient feedback.
All of that said, the no cure, no pay model still has a lot of promise. Hopefully, it will continue to prove advantageous for patients.
You can read more about this new model here.