Prescription medication pay for performance, and the rationale behind it

Are drug companies putting money where their mouths are?

In a new trend, the pharmaceutical industry is offering what the NY Times calls, “money-back guarantees,” essentially paying for treatments if their drug fails.

For instance, the makers of the osteoporosis drug Actonel will pay “$30,000 for a hip fracture . . and $6,000 for a wrist fracture,” if a patient taking their drug suffers those conditions.

In another example, drug maker Merck is offering Cigna patients greater discounts on their diabetes medication Januvia, by offering it on a lower tier. The hope is that Cigna will find its costs reduced from Januvia’s efficacy, and Merck will benefit from more of their drug being used.

These are sly ways to keep patients from choosing generic substitute, or in Januvia’s case, a generic alternative. Also, these bonuses and discounts only apply to specific insurance companies. So, if a patient switches from Cigna to another insurer, it is likely that Januvia will jump to a higher tier.

Merrill Goozner has a more skeptical take, calling the tactics “a minor price discount that brings the price of the drug only slightly more in line with its true value.”

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  • Anonymous

    I’m not sure this is an idea that physicians should support. It gives a wrong idea about what medicines (and by extension the health care) do. Actonel (and other bisphosponates) have not been shown to prevent fractures completely, only reduce the risks of getting a fracture. Hence a fracture on Actonel is not a “failure”. It seems that pharmaceutical companies should reduce the cost of drugs instead Imagine how much actonel you can buy with $30,000: at $105.11 from drugstore.com for a month for 35mg #4, you can buy 285 monthly courses, or enough for one year for 23 people; alendronate 70mg #4 costs $32.99 a month means you can cover 75 people for a year.

  • Aubrey Blumsohn

    The above makes it clear what a good gamble this is for P&G. In fact the paradox is that the whole reason this gimmick works is not because Actonel is good, but because it is so non-cost effective.

    We could reasonably assume that 100 people would be treated for 3 years to prevent one hip fracture and to activate this claim for hip fracture prevention (P&G requires a decent use of the drug to activate a claim).

    At $105.11 from per month x 36 months x 200 people = a drug spend of £756,000 (for a payback of 30K). Given that part of the aim is to prevent users from changing to a generic, and also to provide some free misleading advertising

    it's a great deal…..

    But the advertisement backfires badly given that it is such an admission of poor cost effectiveness.

    Aubrey Blumsohn
    http://scientific-misconduct.blogspot.com

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