If the Patient dies, pays the insurance company less

Several health insurance companies pay for a new cancer drug from Novartis, in the future, continuing the success of the therapy. Specifically, this means: to Die to the patient within a certain period of time, pays the pharmaceutical company for a share of the costs, such as Novartis in a press release reported.

Accordingly, the pharmaceutical company has concluded a corresponding contract with the GWQ service plus, a service company for small and medium sized health insurance companies. It is a pilot project in the German healthcare system, which could come in the future, however, for many of the therapies in question. First, the “Frankfurter Allgemeine Zeitung had reported” over the development.

Specifically, it is in the contract to the gene therapy Kymriah, in the case of the blood cancer patients with their own genetically altered cells to be treated. For this, Doctors remove the patient’s immune cells, which are reprogrammed in the laboratory so that they attack cancer cells. The tailor-made therapy currently costs € 320,000.

For patients in whom other therapies have failed, the treatment is the last hope. In the best case, it ensures that no cancer cells are no longer detectable. “The patients have a real Chance at long-term Survival,” writes Novartis. However, the changes can lead to immune cells to a derailment of the immune system and in the worst case, death.

High costs, uncertain Benefits

Health insurance companies this poses enormous challenges: It is always more Gent urge therapies on the market, which are associated with enormous costs, but also with high hopes for the individual. However, the customized funds have been tested in the market introduction is often only a few patients, so hard to say how big the chances of success really are.

At the same time, prices in the year after the market introduction of especially high, as businesses can set in this period, the cost of your medicines you can, before you enter into negotiations with the health insurance companies. In combination with the uncertainty about the Benefits of the therapies, the risk that innovation patients not achieve.

This is a Problem of the new approach is intended to solve, to make up for the cost of the treatment success. The industry speaks of the “Pay-for-Performance”contracts. Novartis is hoping for a wider application of the extremely expensive resources, and the health insurance companies a better Predictability of the costs and Benefits.

“The contract between the GWQ and Novartis, makes it clear that it is possible to work together to develop sustainable solutions for the health care system and at the same time promote the rapid patient access to therapeutic innovation,” said Oliver Harks of GWQ in a press release. This means, however, that sums of money are linked with people’s lives.

Further contracts in the case of Multiple-sclerosis-therapy

How much is the refund will be in the event of death of the patient, not reported, Novartis. Also, there is no information as to what is the survival time of the therapy, by Definition, was a success. It is clear, however, that the contract is only for the period up to mid-September. Then, the agent is a year on the market and the price negotiations are completed. In General, the costs decrease significantly.

Although the current case involves only a few patients. Since Kymriah is only approved as a last resort in the case of two forms of cancer, comes into question it only for a few Hundred patients in Germany. The cash composite of GWQ is “FAZ” at just under 8 million Insured with up to ten affected patients in the year. The scheme, however, could be a model for the payment of additional innovative therapies entering the market and the health care system enormous costs.

GWQ had already been acting in the last autumn, a “Pay-for-Performance”contract for a Multiple sclerosis therapy. “Not the treatment with the patent protected active ingredient and a different therapy is necessary, the manufacturer assumes the cost of this therapy,” – said in a statement.

Experts have, for years, a very different proposal for how the drugs could reduce costs: they demand that after a year, between funds and companies, negotiated prices should also apply retroactively. Then the company would have to pay back the higher cost and would have no incentives to demand in the first year, the moon prices.