Some pharmaceuticals companies have negotiated a new payment plan with insurers based on a pretty exciting claim: our products work, and we'll suffer the economic consequences if they don't. Several companies, including Merck and Proctor & Gamble, are linking their charges to whether the patient gets better, reports the New York Times. Basically payment becomes about quality, not quantity, which is what we'd like to see for the health care system as a whole.

The makers of the osteoporosis drug Actonel agreed to help insurer Health Alliance pay for the care if a patient suffers a nonspinal fracture despite taking the bone-protecting drug properly. It's win-win—the insurer can save money, and the drugmakers are less likely to lose market share to generic versions of Foxomax, another osteoporosis drug.

Cigna and Merck made a similar deal, with Merck promising to reimburse Cigna on certain diabetes medications if patients comply with their recommended doses. Though it seems like a pretty easy task to just take the medicine your doctor prescribes, failure to comply with treatment is more about cost than anything else, so the health plans are going to have to push for compliance programs (which are good for patients). The high price of drug co-pays makes it difficult for patients to fill every prescription on time, especially during troubling economic times. This leads to poor health outcomes, and costs insurers and health providers more in the long-run, because patients with worsening conditions require more expensive care. Offering this program for diabetes management is an especially wise investment, as chronic care is an extremely costly aspect of our health care system. Merck has even gone so far as to offer discounts for patients with better blood sugar control, whether the improvement comes from the use of Merck's diabetes drugs, or other medications.

With some patients and health care providers turning to generic drugs to lower costs and increase compliance, Merck and Proctor & Gamble are displaying a significant show of confidence in their products. "We're willing to put our money where our mouth is," Dan Hecht, general manager of pharmaceutical business of Procter & Gamble, which sells Actonel, told the New York Times.

For all those of us supporting evidence-based practice and payment reform based on quality of care delivered and positive outcomes, this is an important step. Building a sustainable system of health care delivery is going to require payment reform that promotes value, wellness, and prevention. And who doesn't like a money back guarantee?