Shoppers are used to money back guarantees for everything from razors to toilet paper. But consumer products aren’t the only things now offering purchase protection. Your health plan may be getting reimbursements for some of the medications you take.
“Money back guarantees for drugs is a relatively new phenomenon, “ according to Mark Fendrick, MD, Director of University of Michigan Center for Value Based Insurance Design.
Some prescription drugs now promise to perform or the manufacturer or pharmacy benefit company will provide a discount or refund.
Before you get too excited, though, Dr. Fendrick says, in most cases, the refunds don’t go directly to patients. “In the early situations, most of the time the money goes back to the health plan or the employer,” he says.
One example: Cigna says it has entered into “value-based contracts” for medications designed to treat conditions such as heart failure and multiple sclerosis. There are agreed upon health metrics to measure whether a drug meets expectations.
Under some contracts, if a drug doesn’t perform as expected, the manufacturer will reduce the cost to Cigna’s benefit plans.
The company says these deals “align financial terms to measured improvements in customers’ health.”
David Mitchell, of “Patients for Affordable Drugs”, says the guarantees are little comfort to sick patients.
"Money-back guarantees don’t work because it allows the manufacturer to keep control of the price of the drug, and... no drug should be given to people if they are not effective to begin with and the FDA determines that.”
Dr. Fendrick says, in some cases, guarantees won’t directly impact patient costs, but they are supposed to help insurers keep premiums from going up.
“It’s increasing accountability and transparency for drugs and drug effectiveness.”
Novartis, which makes some drugs that offer rebates and guarantees tells us “By collaborating with payers on outcome based contracting solutions, we hope to help drive a shift toward value pricing in the healthcare system.”
Express-Scripts offers its own guarantees and tells us its Hepatitis-C program has lowered the cost of the treatment to payers by nearly 50% since 2015 and has granted 50,000 patients access to care that may be rationed by some providers.
To find out if a medication you are taking offers guarantees and to ask what is being done with any potential refunds, call your insurance provider. Dr. Fendrick believes as the guarantees become more common, patients will get a piece of the refund pie.