{"entity":{"id":"idea-reg-social-impact-bond-switching","kind":"idea","name":"Social impact bonds that fund biosimilar switching, repaid from payer savings","aka":[],"tldr":"Hospitals often lack the staff to switch patients to cheaper equivalent drugs. Private investors could fund the switching teams and be repaid by the health system from the money saved.","summary":"Switching programmes (pharmacists, patient information, prescribing system changes) return far more in drug savings than they cost, but compete for scarce operating budgets. A social impact bond raises private capital to fund the programme and repays investors, with a return, from verified savings measured against a pre-agreed baseline; the payer pays only if savings materialise. Social impact bonds have been used in social care and public health; oncology drug switching has an unusually measurable outcome.","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":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-drug-pricing","b-funding-allocation"],"keyPapers":["paper-prasad-nat-rev-clin-oncol"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Bond-funded switching programmes achieve biosimilar and generic shares above 85% within a year and generate verified savings at least five times the programme cost, with investors repaid in full.","rationale":"The savings from switching are large, fast and measurable from claims data, which is exactly the profile that makes outcome-based financing work; the constraint is up-front capacity, which the bond supplies.","test":"Structure one bond covering ten hospitals for two new oncology biosimilar launches, with an independent evaluator verifying savings, and publish the returns and clinical safety data.","maturity":"speculative","actor":"philanthropy","cost":"medium","horizonYears":2},"route":"/ideas/idea-reg-social-impact-bond-switching/","neighbours":{"bottleneck":[{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/"},{"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/"}]}}