Intended for healthcare professionals

Education And Debate

No cure, no pay

BMJ 2005; 330 doi: (Published 26 May 2005) Cite this as: BMJ 2005;330:1262
  1. Claus M⊘ldrup, associate professor (
  1. 1 Department of Social Pharmacy, Danish University of Pharmaceutical Sciences, Universitetsparken 2, DK-2100 Copenhagen ⊘, Denmark
  • Accepted 7 March 2005

Not paying for a drug unless it works sounds great for patients and healthcare funders, but it could also benefit manufacturers.


Tensions between the pharmaceutical industry and health authorities over drug marketing have increased in recent decades. The authorities want to get the most possible drug for their money whereas drug companies want to get the most money for their drugs.1 2 The current situation is untenable first and foremost for the industry but also for the authorities, and, in the end, the patients. This article proposes how a no cure, no pay strategy could meet the needs of all parties and contribute to a sustainable future for the medical environment as a whole.

Collision course

Marketing tensions are neither new nor odious, but two factors in particular have put the two opposing sides on a collision course. On one side, the authorities have fewer financial resources at their disposal relative to the many drug options available and the increasing need for treatment caused by a swell in the ageing population. Fewer resources naturally lead to increased focus on how money should be spent and what the return is in practice. This has caused the authorities to focus more on clinical evidence and relevance in the choice of drug treatment. In turn, this has led to the introduction of the concept of rational pharmacotherapy as a political tool for ordering priorities (box 1).3 4

Box 1: Rational pharmacotherapy

Rational pharmacotherapy is defined as drug treatment that provides the greatest effect with the least serious and fewest side effects at the lowest possible price.5 The following equation is used to illustrate the idea: Effect (clinical studies)+extent of side effects/price = extent of rational pharmacotherapy

On the other side, drug companies have had to become more competitive as a result of the falling number of …

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