How have other health systems handled Zolgensma's cost?
England's NHS reached a confidential 2021 deal for eligible infants; US insurers accepted instalment and outcomes-based arrangements; but ICER's president acknowledged they "were going to cover Zolgensma no matter the price" — illustrating payers' limited leverage with curative therapies.
Outside the US, health systems have generally negotiated confidential arrangements. In March 2021 England's NHS reached a confidential agreement with Novartis to provide Zolgensma to eligible infants with Type 1 SMA. In the US, Novartis worked with insurers such as Cigna on instalment payments and outcomes-based agreements, under which it would refund part of the cost if treatment failed. Health Affairs critics noted that the instalment plan still ensured Novartis would be fully paid within five years, while the long-term durability of benefit was unknown. ICER's president acknowledged that insurers "were going to cover Zolgensma no matter the price", which illustrates how little leverage payers have with one-time curative therapies.