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By Uri Baruch, James Baker and Tom Lawrie-Fussey
Recently, a major drug distributor announced that it would offer refunds to any patient that suffered a heart attack whilst being prescribed their latest cholesterol-lowering drug; this is essentially the refund based business model that has previously been conceptualised and debated in the healthcare industry.
There are many considerations to operating this way within the healthcare industry; from the patients perspective there is clearly a benefit if the drug works as claimed and the patient outcome improves, and from the payers perspective the prescription becomes more financially viable which could lead to more patients receiving the benefits with reduced risk. However, is it the patients that get monetary compensation if their health doesn’t improve sufficiently from this treatment? Unlikely. In the UK with paid for prescriptions and those with medical insurance in the US, the patient is not paying out of their pocket, so the refund is directed at the drug purchasers such as the NHS.
Furthermore, it could be argued that it is counter intuitive to expect any party to gain anything if the patient continues to suffer complications. Indeed, if there was a benefit financially from such events, it might even drive negative behaviours. Worryingly then, this refund model isn’t perhaps focused entirely on the patient.
One of the most challenging problems facing the healthcare industry that urgently needs addressing is adherence. As many as 50% of patients taking cholesterol-lowering medication stop within the first year and this continues to fall with time 1. With the refund approach, what isn’t mentioned is how the patient will be incentivised to take their medication which is surely the most crucial part of the equation. Drug adherence will be won by finding innovative ways to convince the patient to take, and continue to take, their medication.
As reimbursement models dictate that more is known about actual patient usage, the need to get the patient experience right becomes ever more urgent. Without the patient being fully committed, any new financial models, particularly the attention-grabbing ones, are still unlikely to get the best patient outcome.
The insurance companies in the US, coupled with imminent regulatory drivers, are helping to incentivise towards an outcome-driven reimbursement model approach. They want to see evidence of successful outcomes, and the pharma companies want to further differentiate their latest drug offerings. The impact on drug distributors for the likely few patients who will suffer a heart attack during treatment seems insignificant when compared to the overall prescription costs.
If you’d like to better understand how to engage and interact with the patient, we have a team of user-experience experts who specialise in uncovering exactly those opportunities. Our approach helps to inform our clients of these crucial development decisions and ultimately leads to happier patients, and better outcomes for us all. Contact us at firstname.lastname@example.org.
1 - NCBI (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534845/)
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