# Cap public prices for new cancer drugs to tiers of the ESMO and ASCO value scales

Source: https://onco.cc/ideas/idea-reg-price-anchored-to-mcbs/  
OnCo record `idea-reg-price-anchored-to-mcbs` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Oncology societies already grade how much benefit each new drug gives. Payers should tie the maximum price they pay to that grade.

## Summary

The ESMO Magnitude of Clinical Benefit Scale and ASCO Value Framework grade drugs by survival gain, quality of life and toxicity, but prices bear little relation to the grades; several analyses find no correlation between price and benefit. The proposal is for a coalition of public payers to publish a price corridor per benefit tier (for example a multiple of GDP per capita per life-year gained for grade 4-5 versus a much lower ceiling for grade 1-2) and to make the tier a binding input to negotiation, with prices revisited when confirmatory data change the grade.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Payers adopting tiered ceilings pay prices correlated with benefit (Spearman rho above 0.5, from near zero today) and see lower growth in oncology drug spend without reducing the number of high-benefit drugs reimbursed.
- Rationale: Transparent, benefit-linked ceilings give manufacturers a predictable target and reward developing drugs with large effects; the absence of any benefit-price relationship is the clearest symptom of a broken market.
- Proposed test: Retrospectively apply tiered ceilings to the last decade of oncology approvals in one country to model spend and access; then adopt prospectively in a coalition of two or three payers and measure correlation and spend after three years.
- Maturity: speculative
- Actor: payer

## Sources

- Bottleneck evidence (Prices and value): Prasad, De Jesús & Mailankody, The high price of anticancer drugs: origins, implications, barriers, solutions (Nat Rev Clin Oncol 2017): https://doi.org/10.1038/nrclinonc.2017.31

## Connected records

- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)
- key papers: [The high price of anticancer drugs: origins, implications, barriers, solutions](https://onco.cc/key-papers/paper-prasad-nat-rev-clin-oncol/)
- roadmaps: [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/)

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