27 March 2019 - In the battle over the pricing of new drugs, manufacturers and payers have sought to come up with novel approaches to pricing that can be tolerated by both parties. 

One such approach has been to provide a type of money-back guarantee for expensive new drugs. In what are called outcomes-based agreements, prices are agreed to by payers with the caveat that if the drug doesn’t perform up to patients’ and physicians’ expectations, the company will refund part, if not all, of the cost of the drug.

An early adopter of this paradigm was Amgen with its LDL-cholesterol drug, Repatha. Amgen faced a lot of resistance on the part of payers who made it difficult for patients to get access to this drug. While Repatha had been shown in a major clinical study to reduce heart attacks and strokes, its original high list price of $14,600/year was a big issue for payers. They felt that the amount of cardiovascular risk reduction (when combined with statins) that was achieved with Repatha wasn’t worth the drug’s price.

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