But it turns out that "what the market will bear" gets really expensive, particularly when the people who need the medications are not, directly at least, the ones paying for them.

The cost of drugs is a problem, with increases in prices drastically outpacing inflation.

And we have heard some talk from politicians on both sides of the aisle that something needs to be done.

But don't worry folks. Big Pharma has the solution. It's called outcomes-based contracting. The basic idea – pay for this drug, and if it doesn't work, you get your money back.

If you think this is a good deal, I have a bridge to sell you. But don't take my word for it.

A new study, appearing in the Annals of Internal Medicine, looks at the PCSK-9 inhibitor evolocumab.

This is a novel lipid-lowering agent that comes in at a whopping $14,500 per year – the price the market will bear. Clinical trials show that this drug does save lives, at a cost of around $324,000 per quality-adjusted life year saved. Most health economists "value" a life-year at $100,000, so one could argue this drug costs more than 3-fold what it is worth.

But Amgen, the maker of evolocumab, has a deal for you. If you have a heart attack or stroke within 5-years of starting the drug, you get your money back.

Sound good?

It's not.

The Annals paper quantifies what you should feel in your gut. Strokes and heart attacks are rare – only about 3% per year in the high-risk group that would be receiving evolocumab. That means that 97% of people are paying full price.