Insurance switching and mismatch between the costs and benefits of new technologies.

As scientific advances generate transformative therapies with substantial structural disconnects between "who pays" and "who benefits," creative approaches may be needed by manufacturers, payers, and others to ensure appropriate access to cost-effective therapies, adequate economic incentives for future development, and sustainable payer economics. Mechanisms may amortize high up-front costs over time, provide for transfers among payers, or a combination. Our research suggests that approaches should be tailored to specific disease and therapy characteristics to be effective.