Effective new drugs can make the world a better place — unless they aren’t accessible because those making the breakthroughs charge an enormous price to get a decent profit because they can, or because their investors demand it.
People who create viable businesses and their investors have a right to earn a return on the resources they expend to solve a problem, including finding cures for previously incurable diseases. But that is turning out to be problematic when it comes to new medicines, especially those with million-dollar price tags.
A recent Wall Street Journal article focused on a newly approved leukemia treatment with a high success rate. The total treatment cost nearly $1 million, including as much as $475,000 just for the medicine.
Spark Therapeutics has said it would charge $850,000 for a new treatment for a hereditary form of vision loss. Novartis believes its new gene therapy for spinal muscular atrophy is worth more than $4 million for a one-time dose. Even if it’s about half that amount, that’s as much as the average American earns over a lifetime.
Cures for diseases like cancer, diabetes, blindness, and Alzheimer’s may well be within reach in the next few decades. But there are two looming questions: What they will cost? And how we will pay for them?
Health insurers balk at covering new, high-cost medicines if these therapies don’t fit neatly into the procedure codes they use to determine “reasonable and customary charges.” In addition, one or two such claims are likely to use up much of the insurance pool, making high-cost drugs impractical to cover.
A better way is to take a page from the insurance model of pooling or sharing risk and betting on outcomes. Insurers charge a relatively small premium spread across a large population — a reverse lottery where the winner has a loss that the insurer covers. Homeowners, for example, don’t question the value of paying the equivalent of less than 1 percent of the value of their homes to have them replaced if they’re destroyed.
I’ll use cancer to illustrate the concept of a new financial instrument that’s something like a futures contract. The American Cancer Society says nearly 40 percent of Americans will get some form of cancer during their lifetimes, and 1 in 5 will die of it.
You could buy a futures contract as a call option for the right to purchase a therapy that has not yet been invented but is close. Individuals would pay something, say $250 a year for illustration purposes, for the right to buy a disease-specific cure at a fixed affordable amount, one that their health plan would likely cover. Contract owners who end up not needing this cure could sell their contracts to people who need or want access to it. For multiple diseases, one would need to buy multiple contracts.
That annual option purchase, paid by tens of millions of people to the institutions working on cures for specific diseases, would help fund research into new drugs and make the resulting cures more affordable. Think of it as a giant Kickstarter campaign.
Experiments fail, and fail again, though they sometimes get closer with each iteration. When the funds run out, researchers need more money to get closer and closer. Some of that comes from fundraisers, charity groups, and other not-for-profit groups. Some of it comes from private investors, but they need to get paid back.
In tapping the masses for a larger and more dependable stream of money, they would “get paid back” by guaranteeing them access to a cure once it is invented. “Access” doesn’t mean free, just affordable for non-millionaires. Ten million people investing $250 a year in the future cure for a disease, in exchange for the right to buy that cure should they need it, would raise $2.5 billion per year to help fund the search. To put this in perspective, it takes an average of 10 years and $2.6 billion to discover a new medicine and get it approved by the FDA.
If 10 pharmaceutical companies agree to be part of this program, they get to split that money, giving each company $250 million more per year to work toward the cure. These additional resources might shorten the time it takes to find a cure. Anyone who bought the futures call option could buy the cure for say $5,000 — the strike price, in options parlance, that would presumably be a fraction of the market price.
This could be an effective supplement to health insurance. It has no qualification requirements, because the investor’s risk profile doesn’t matter. The sick and the well have equal access, and the companies inventing the cure face little risk because they would have been paid along the way.
The hospital and medical centers administering these cures may need to share in this pre-funding mechanism, because the cost of administration can often be higher than the cost of the drug itself.
How many people in the world have the wherewithal, let alone the motivation, to pay a $250 a year for access to a cure that might never be found for a disease they might never get? That’s hard to say, but it isn’t a reason not to explore the market’s appetite for cure futures contracts. Millions of Americans pay hundreds of dollars a year for warranties on products that almost never break.
Insurance companies already sell cancer insurance, but the coverage is limited and doesn’t guarantee the insured will have access to the latest, pricey medical breakthrough.
A contract that would guarantee access to a cure at a time when such cures appear increasingly likely might seem like a bridge too far, but society has met such challenges in the past. Health insurers do it by collaborating with health-care providers, researchers, regulators and, most important, end users — the people who need these drugs and their families — all with a common goal: to make the world a better place.
With costly miracle cures on the horizon, it’s time for drug companies to join forces with the financial services industry to solve the problem of cures that almost no one can afford.
Maria Ferrante-Schepis is the president of Maddock Douglas, an innovation consulting company.