[To reimburse or not? Evaluating expensive drugs differently].

Health insurance organisations grant reimbursement for drug treatment on the basis of results of placebo-controlled randomised clinical trials showing a clinically meaningful and statistically significant effect over placebo. This often proves problematic in rare diseases as well as in many chronic diseases that are difficult to treat. Clinical scientists may address the issue by testing the drug on surrogate outcome parameters and ask for post-marketing studies conducted by expert reference centres as expediency research, using budgets provided by the government to show that the drug really works in terms of real-life patient experience. In the past 5 years, the pharmaceutical industry has released an increasing number of expensive drugs for rare diseases; this jeopardises the solidarity of health insurance cover for all EU citizens. To facilitate drug development, a new model might benefit all key players involved. The foundation Fair Medicine recently called for coalitions that jointly develop medicines based on contribution and complementarity, sharing responsibilities, risks and rewards.