{"entity":{"id":"idea-cost-managed-access-everywhere","kind":"idea","name":"Copy the Cancer Drugs Fund: pay for uncertain drugs while collecting the data","aka":[],"tldr":"Since 2016 England's Cancer Drugs Fund has paid a confidential discounted price for cancer drugs whose benefit is plausible but unproven, collected outcome data for two or three years, then had NICE decide for good; most drugs that entered were later recommended. Other systems could use the same managed-access deal instead of a yes-or-no at launch.","summary":"Since July 2016 England's Cancer Drugs Fund has operated as a managed-access scheme: NICE identifies drugs with plausible but uncertain benefit, NHS England pays a confidential discounted price under a fixed budget with an expenditure-control mechanism, and Public Health England collects outcome data; NICE then reappraises. Most drugs that entered have since been recommended for routine use. The model gives patients early access and gives the payer leverage and evidence. Germany's AMNOG, Canada's time-limited recommendations and Medicare's coverage with evidence development are partial versions.","asOf":"2026-09-10","links":[{"label":"NHS England: Cancer Drugs Fund","url":"https://www.england.nhs.uk/cancer/cdf/"},{"label":"OnCo: What the NHS offers","url":"https://onco-umber.vercel.app/coverage/uk/"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["nice","g-ba-iqwig","pbac"],"pathways":[],"terms":["real-world-evidence"],"trials":[],"people":[],"bottlenecks":["b-drug-pricing","b-real-world-evidence","b-regulatory-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Managed-access schemes with a fixed budget and mandatory data collection will deliver access one to two years earlier than standard appraisal at net prices at least 20% below list, with fewer than one in five drugs later withdrawn.","rationale":"The English scheme has published its outcomes; the mechanism is transferable to any single payer or large insurer.","test":"Adoption by two further systems with comparison of time to access, net price, evidence generated and final decisions against their prior process.","maturity":"being-tested-at-scale","actor":"policy","cost":"medium","horizonYears":3},"route":"/ideas/idea-cost-managed-access-everywhere/","neighbours":{"institution":[{"id":"g-ba-iqwig","kind":"institution","name":"Gemeinsamer Bundesausschuss / IQWiG","route":"/institutions/g-ba-iqwig/"},{"id":"nice","kind":"institution","name":"National Institute for Health and Care Excellence","route":"/institutions/nice/"},{"id":"pbac","kind":"institution","name":"Pharmaceutical Benefits Advisory Committee","route":"/institutions/pbac/"}],"term":[{"id":"real-world-evidence","kind":"term","name":"Real-world evidence","route":"/terms/real-world-evidence/"}],"bottleneck":[{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"},{"id":"b-regulatory-fragmentation","kind":"bottleneck","name":"Regulatory divergence between regions","route":"/bottlenecks/b-regulatory-fragmentation/"},{"id":"b-real-world-evidence","kind":"bottleneck","name":"Weak real-world evidence and registries","route":"/bottlenecks/b-real-world-evidence/"}]}}