By NextBestFitPrize funds and advance market commitments
Pay large prizes or guaranteed purchases for drugs meeting set goals (e.g., new antibiotics), then sell at low prices.
Start with antibiotics, where markets fail.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Create a prize fund for set goals
- Set advance market commitments for antibiotics
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- R&D is funded by high prices, which ties innovation to unaffordability
Prizes or guaranteed purchases reward drugs meeting specified goals without requiring high selling prices, including in neglected areas such as antibiotics.
- Brand-name drug prices far above production cost
Prizes or guaranteed purchases pay for innovation so qualifying drugs can then be sold at low prices.
- Depends on uncertain evidence or judgments
Prize funds require judgments about reward sizes that are difficult to set correctly. Prize funds and guaranteed purchases remain untested at large scale.
- Government chooses which research gets funded
Government defines which drug-development goals qualify for prizes or guaranteed purchases.
Who's affected
- People with ongoing or specialist care needs
- R&D is funded by high prices, which ties innovation to unaffordability: High prices make current treatment less affordable.
- People who will need care in the future
- R&D is funded by high prices, which ties innovation to unaffordability: Price cuts without replacement research funding can reduce the development of new drugs.
- People with unaffordable deductibles or coinsurance
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Uninsured people
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Health insurers, brokers, and their shareholders
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Taxpayers and public budgets
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Medical researchers and research institutions
- Government chooses which research gets funded: Well-connected institutions can benefit from politically influenced research funding.
- Drug and device makers
- R&D is funded by high prices, which ties innovation to unaffordability: High prices fund research and support expected investor returns.
- Brand-name drug prices far above production cost: Market exclusivity supports high prices and shareholder returns.
- Pharmacy benefit managers and their pharmacies
- Brand-name drug prices far above production cost: High list prices generate rebates for benefit managers.
- Taxpayers and public budgets
- Depends on uncertain evidence or judgments: Prize funds require judgments about reward sizes that are difficult to set correctly. Prize funds and guaranteed purchases remain untested at large scale.
- Medical researchers and research institutions
- Government chooses which research gets funded: Government priorities may leave risky or politically disfavored research unfunded.
- People with ongoing or specialist care needs
- Government chooses which research gets funded: People with rare conditions can lose research support for needed treatments.
Where it has been tried
- UK antibiotic subscription model (2022): Pays a fixed annual fee for new antibiotics regardless of use.
- England, United Kingdom: In 2022, NHS antibiotic subscription contracts offered up to £10 million a year for up to 10 years, regardless of prescribing volume.Sources: NHS England (2022)