The complicated case for prescription drug refunds and guarantees

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Some prescription drugs now promise to perform or the manufacturer or pharmacy benefit company will provide a discount or refund. (KFSN)

From Capitol Hill to your corner pharmacy, the cost of prescription drugs is one of the hottest topics across the country. It's estimated consumers spend over $300 billion a year on medications.

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.

"Money back guarantees for drugs is a relatively new phenomenon," Dr. Mark Fendrick with Value Based Insurance Design said.

Some prescription drugs now promise to perform, or the manufacturer or pharmacy benefits company will provide a discount or refund. But before you get too excited, medical experts say, 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," Fendrick said.

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.

"A: Money-back guarantees don't work because it allows the manufacturer to keep control of the price of the drug, and, two, no drug should be given to people if they are not effective to begin with, and the FDA determines that," he explained.

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," Fendrick said.

Novartis, which makes some drugs that offer rebates and guarantees, says "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 for payers by nearly 50 percent" since 2015.

The mail order company has granted 50,000 patients access to care that may be rationed by some providers. Mitchell, a cancer patient himself, feels there's a better way.

"Let's just lower the price at the outset," he said.

To find out if a medication you are taking offers guarantees, including any potential refunds you may be eligible for, call your insurance provider.

Related Topics:
healthhealth carehealthprescription drugs
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