The draft MAHA report recognizes the huge potential of repurposing old drugs. This is an exciting development – hundreds of promising drug-disease combinations remain underexplored because of missing financial incentives. By making drug repurposing a priority, the administration has the chance to improve the health of millions of Americans.
Many drugs have potential uses beyond their original purpose, but once patents expire, repurposing drugs rarely offers a return on investment. Generic competition drives down prices, removing the financial motivation to fund costly research necessary to find new uses. Researchers estimate that 200 to 800 potential drug-disease combinations, worth trillions of dollars, have been held back for this reason.
Despite previous repurposing successes, such as the discovery of COVID-19 treatments and diabetes preventatives, government and philanthropic efforts have faced important limitations. Funding has relied heavily on upfront “push funding” (e.g., research grants). While grants are a crucial part of the toolkit, especially for early-stage research, they involve bureaucrats and program managers placing bets on which researchers and ideas to back. With push funding, taxpayers and donors have to fork out money regardless of success.
To unlock the full potential of drug repurposing, the federal government should complement grants with disease-agnostic pull funding. This would pay innovators for discovering new uses of generic drugs that improve health outcomes. Funders could tie payments to success (i.e., measured adoption of the drug for the new use). Tying payment to success would help attract the best innovators with the most promising ideas. Furthermore, linking payment to adoption would help direct innovators to reach and benefit more people. Disease-agnostic pull funding would encourage innovators to explore the drug-disease landscape, potentially finding opportunities that grant funders would never have picked. This approach aligns with the administration’s broader embrace of prizes, advance market commitments, and other innovative funding tools.
Several agencies could play key roles in advancing this strategy. The National Institutes of Health could structure pull funding to reward breakthroughs tied to patient outcomes, building on its existing authority to offer prizes and flexible contracts. Congressional action could enable such efforts to take place at scale. The Centers for Medicare and Medicaid Services and the Department of Veterans Affairs’ innovation centers could pilot “value-based” payment models that commit to covering the repurposed generic drugs that generate cost savings. The Food and Drug Administration could help by clarifying approval pathways.
By pull funding repurposed generic drugs, the administration can help realize one of the greatest underused opportunities in health care: affordable and effective treatments hiding in plain sight.
