If a pay for success model could provide more QALYs at a lower cost than patented drugs, there would be no need to limit patent protections: the model would sim

If a pay for success model could provide more QALYs at a lower cost than patented drugs, there would be no need to limit patent protections: the model would simply outcompete the patent system. Payers would instead "buy" successful RCT data for repurposed off-patent drugs via pay for success contracts instead and potentially save trillions of dollars as a result. In my view, there is a role for new patented drugs, but this model will reduce pharma's ability to game the patent system via "evergreening" (e.g. releasing a slightly tweaked formulation of a drug just prior to expiry of the old generic and trying to get doctors to switch to new formulation using excessive marketing). It would give payers another option other than patented drugs to buy successful RCT data.