Pay Only for Drugs That Help You

Here’s how this “pay-for-response model” would work: Say a drug company receives approval for a breast cancer drug. Potential patients would be screened to determine whether their cancer was likely to respond to the drug, depending on whether it had, for example, a particular genetic marker. Most of the cancers that do should respond to the drug, but the presence of the genetic marker is still no guarantee. The Food and Drug Administration could help to come up with criteria with which to determine whether a patient is responding to a drug. If the patient’s oncologist and radiologist determine that the patient is benefiting based on those criteria, then the drug company should be paid. For a cancer drug, these criteria could include anything from tumor shrinkage to survival. For other diseases, response-to-therapy criteria are more straightforward. Patients withhepatitis C, for example, who realize a “sustained viral response” in which the virus is essentially gone from the blood, would pay for their therapy. Others would not.

Not only would this save money, but it would also push drug companies to figure out why certain patients don’t respond to treatment and what to do about it, and researchers to aggressively study genetic variation in disease before beginning larger studies. It would also encourage testing with multiple drugs, approved and experimental, to target just the right pathways of disease in each and every population. Biotechnology companies like mine could stand to profit from this change, but the overall gains to the health care system would be far larger.