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Focusing on cures

Payers, manufacturers, patients and academics are piloting financing options for curative therapies

A Massachusetts Institute of Technology-led consortium is finalizing pilot programs that are intended to serve as models for overcoming two major hurdles to implementing performance-based contracts for curative therapies in the United States. The goal is to test a series of financial engineering concepts the consortium calls “precision financing.”

One pilot seeks to make multiyear performance-based annuity contracts portable, so they can be handed off when patients who are receiving potentially curative therapies switch insurance companies.

The other pilot attempts to make milestone-based contracts viable for state Medicaid programs, including finding workarounds for the Medicaid Best Price rule.

Both programs will be presented at the Paying for Cures conference in Washington, D.C. on February 12.

The pilots are being led by a project of MIT’s NEWDIGS (NEW Drug Development ParadIGmS) program dubbed FoCUS (Financing and Reimbursement of Cures in the U.S.), which includes biopharma manufacturers, payers, providers and patient advocates.

FoCUS does not consider or attempt to assess how drug prices are set, but assumes that curative therapies will be so costly that creative financing options will be required to pay for them.

“Value is a function of durability,”

Michael Sherman, Harvard Pilgrim Health Care

Mark Trusheim, strategic director at NEWDIGS, describes FoCUS as a “collaborative stealth project that has been going on for two years that is moving these concepts into action. Not just talking academically but moving into real pilots and demonstrating what can be done.”

The group conducted a pipeline analysis that suggests about half a million patients will have been treated in the U.S. with 40 to 60 approved curative therapies by 2030 (see “Cures in the Pipeline”).

Sidebar: Cures in the pipeline

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