Drug Works or Your Money Back
Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work
JULY 21, 2017
Sometimes something comes along that is a big reminder of the kind of work I do, the kind of world I live in, the kind of perspective that I carry. In a million years, it would never have occurred to me that it might be possible to have a money back guarantee for drugs. Sure, I return things all the time (most recently a landline phone that just does not work), but drugs? Never. As clearly as I know anything, I know that it is impossible to promise that a particular drug or treatment will work for everyone. How many times do we hear the phrase: Everyone is different?
And, yet, that apparently has bee discussed. From STAT:
The art of the deal? Why a moneyback guarantee for drugs is a bad idea
By Ed Silverman @Pharmalot
President Trump likes to boast that he mastered the “art of the deal.”
But one option1 his administration is considering to encourage lower drug prices, which surfaced in a recent draft executive order, may not be much of a deal for consumers.
The concept has a clunky name — value-based pricing — but it’s fairly simple. One increasingly popular version works like this: A drug maker refunds some money to an insurer if its medicine fails to improve patient health or prevent a costly incident, such as a heart attack.
Seems like a good idea, yes? Not so fast. There is good reason to be skeptical that prices will drop under this system. Why? In some cases, it may take years to figure out whether a medication is effective for a given patient. And when a drug maker does give a refund, for the most part, that money is unlikely to end up in the hands of consumers.
“It’s not going to lower prices substantially, certainly not in the short term and probably not in the long term,” said Dr. Walid Gellad, an associate professor of medicine and co-director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh. “It’s an easy way out of addressing the real complexities.”
Over the last year or so, several drug makers, including Merck, Eli Lilly, Novartis and Amgen, have struck deals with insurers that promise refunds if patient outcomes aren’t satisfactory. The companies like these deals because they can lock in business for key medicines and, of course, negotiate the metrics that affect refunds.
So the pharmaceutical industry portrays them as win-win paradigm shifts.