The Pharmaceutical Journal Vol 267 No 7174 710-713
17 November 2001

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Letters to the Editor

The industry

Putting its money where its mouth is

From Mr D. Macarthur, MRPharmS

Your editorial discussing the possible use of money-back guarantees for new drugs in the National Health Service (PJ, 3 November, p632) was timely, although there are many practical, legal and ethical problems to overcome.

To my knowledge the approach has not actually been used before in the United Kingdom, although it has been raised from time to time in industry circles. At least one health authority had talks with a manufacturer in 1998 on a pilot scheme in primary care but nothing developed. One of the problems raised at the time was how to handle any refunds, in particular how to repay patients for their prescription charges.

North American experience with efficacy guarantee schemes is more extensive than you indicate, with Pfizer's Cefobid (cefoperazone) in 1984 one of the pioneers. With Cefobid and later with Merck & Co's Proscar (finesteride), also in the US, as well as Rhône-Poulenc Rorer's Taxotere (docetaxol) in Canada, no actual cash rebates were on offer. Instead, the sponsoring company offered free replacement stock if agreed health outcomes were not delivered. How this could transfer to a European health care environment is uncertain. In addition, many elements in industry would argue that any drug with a product licence is effective by definition.

Donald Macarthur
Saffron Walden,
Essex

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