Jacob Kimmel

I do think the broader point of if you have medicines with very long-term durability, how do you reimburse them?

Or if just the benefits are very long-term and, you know, sort of accrue in the out years.

A challenge we have in the U.S.

system is that the average person churns insurers every three to four years.

That number fluctuates around, but that's the right order of magnitude.

And that means that if, for instance, you had a

dramatically reduce the cost of all other healthcare incidents, but it happened exactly five years after you got dosed with it.

No insurer is technically economically incentivized to cover that.

And so I think there are a couple models here that can make sense.

One is something called pay for performance, where rather than reimbursing all of the cost of the drug upfront, you actually reimburse it over time.

So say you get a medicine that just makes you generically healthier and you can measure the reduced rates of heart attack and reduced rates of obesity and various other things.

And you get this one dose and it lasts for 10 years.

Each year you would pay something like a tenth of the cost of the medicine contingent on the idea that it was actually still working for you and you had some way of measuring that.

So that's a big challenge in this industry is like, how would you demonstrate that any one of these medicines is still working for the patient?

In the few examples we have today, these are things like gene therapies where you can just like measure the expression of the gene and like, okay, the drug is still there.

But it gets more complicated when you have some of these sort of longer-term net benefits.

And the idea would be that then each insurer is incentivized to just pay for the time of coverage that you're on their plan.

And we already have a framework for this in post-Affordable Care Act in the U.S., where pre-existing conditions no longer really exist.

So patients are able to freely move between pairs, and you could sort of treat the presence of one of these therapeutics, lowering this patient's overall healthcare costs the same way we treat a pre-existing condition.

I think this is something that the system is still overall figuring out.