Money-back guarantee on drugs benefits companies - not you - NBC12 - WWBT - Richmond, VA News On Your Side

Money-back guarantee on drugs benefits companies - not you

(WWBT) -

From Capitol Hill to the corner pharmacy, the cost of prescription drugs is one of the hottest topics around.

According to the latest numbers, consumers spend more than $300 billion a year on their prescriptions. But did you know you could be getting some money back from some of the medications you take?

"Money back guarantees for drugs is a relatively new phenomenon," said Dr. Mark Fendrick.

The Director of the University of Michigan Center for Value Based Insurance Design says some prescription drugs now promise to perform, otherwise the manufacturer or pharmacy-benefit company will provide a discount or refund.

Before you get too excited, in most cases, the refunds don't go directly to patients.

"Most of the time, the money goes back to the health plan or the employer," said Dr. Fendrick.

One example: Cigna Health Insurance says it has entered into "value-based contracts" for medications designed to treat conditions such as heart failure and multiple sclerosis. They have 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 with 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," said Mitchell. "And no drug should be given to people if they are not effective to begin with, and the FDA determines that."

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," said Dr. Fendrick. 

Drug company Novartis offers rebates and guarantees. It 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 says its Hepatitis C program has "lowered the cost of the treatment for payers by nearly 50 percent" since 2015. The company says it 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.

At this moment, the only way for you to find out if a medication you are taking offers "guarantees" is to ask, meaning a phone call to your insurance provider. It's also the only way to question what's being done with any potential refunds.

Some believe, as this practice of offering guarantees becomes more common, patients will eventually get a piece of the refund pie.

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