{"entity":{"id":"idea-moon-pay-for-cure-contracts","kind":"idea","name":"Pay-for-cure contracts: instalment payments for curative therapies contingent on durable remission","aka":[],"tldr":"For very expensive one-time treatments such as CAR-T, pay in instalments over years and stop paying if the cancer comes back, so price tracks the cure actually delivered.","summary":"One-time curative-intent therapies (CAR-T, gene therapies, potentially in vivo cell therapy) carry prices that health systems struggle to absorb up front and that are not tied to durability. Outcome-based agreements exist in a few countries. The proposal is a standard contract framework: payments spread over five years, annual instalments contingent on registry-verified remission, portability across payers when patients move, and public reporting of durability, with the same framework offered in middle-income countries at tiered prices.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Prices and value): Prasad, De Jesús & Mailankody, The high price of anticancer drugs: origins, implications, barriers, solutions (Nat Rev Clin Oncol 2017)","url":"https://doi.org/10.1038/nrclinonc.2017.31"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":["car-t"],"targets":[],"drugs":["axicabtagene-ciloleucel","ciltacabtagene-autoleucel"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-drug-pricing","b-incentive-misalignment"],"keyPapers":["paper-prasad-nat-rev-clin-oncol"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Pay-for-cure contracts increase the number of patients treated with curative therapies by a third at the same budget and shift manufacturer investment toward durability of response.","rationale":"Aligning payment with the outcome that matters removes the payer's risk on unproven durability and rewards manufacturers for cures rather than infusions.","test":"Implement for CAR-T in two national payers; compare patients treated, budget impact and durability data quality against payers using up-front payment.","maturity":"early-clinical","actor":"payer","cost":"medium","horizonYears":4},"route":"/ideas/idea-moon-pay-for-cure-contracts/","neighbours":{"technology":[{"id":"car-t","kind":"technology","name":"CAR-T cell therapy","route":"/technologies/car-t/"}],"drug":[{"id":"axicabtagene-ciloleucel","kind":"drug","name":"Axicabtagene ciloleucel","route":"/drugs/axicabtagene-ciloleucel/"},{"id":"ciltacabtagene-autoleucel","kind":"drug","name":"Ciltacabtagene autoleucel","route":"/drugs/ciltacabtagene-autoleucel/"}],"bottleneck":[{"id":"b-incentive-misalignment","kind":"bottleneck","name":"Incentives reward me-too drugs and marginal gains","route":"/bottlenecks/b-incentive-misalignment/"},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"}],"paper":[{"id":"paper-prasad-nat-rev-clin-oncol","kind":"paper","name":"The high price of anticancer drugs: origins, implications, barriers, solutions","route":"/key-papers/paper-prasad-nat-rev-clin-oncol/"}]}}