Possible Medicare Formulary Outreach.
Did I just find a headline more boring than "Worthwhile Canadian Initiative" ?
I don't know, but I am genuinely exited about the topic (too much coffee I guess).
I think the Medicare administration should be allowed to exclude an FDA approved pharmaceutical from its formulary if a committee of doctors agrees that there is a cheaper equally effective alternative. I also think that this should only be allowed after the medicare administration engages in good faith negotiations with the manufacturer lasting at least 60 days and ending in an impass (wording like the Taft-Hartley act wording on strikes). Finally I think the medicare administration should publicize it's list of FDA approved drupgs not in the formulary (that is for which it will not pay) with press releases, on the web and allong with all payments to physicians.
Finally, I really like the idea that congress could declare it's view that if physicians prescribe drugs not on the formulary they must receive consent from patients after informing them that the patient will pay, that the medicare administration will pay for another drug which they claim is just as good and that the physician doesn't agree with the medicare administration. Failure to receive such informed consent would (in congress's not necessarily authoritative view) expose the physician to civil liability for the cost of the drug.
An interesting issue in the US policy debate is the appalling giveaway to big Pharma in the Republican Medicare plan D bill which forbids the Medicare administration to negotiate the price it pays for pharmaceuticals. Needless to say, the public is strongly opposed to this provision. However, the public doesn't want restrictions on which pharmaceuticals are covered by Medicare plan D.
Thus the public seems to support the idiotic bill working its way through congress which will enable the medicare administration to negotiate prices but does not allow it to threaten to not pay for a pharmaceutical if the manufacturer demands to high a price. Aside from the question of whether such threatless negotiation is a contradiction in terms (and the even less interesting question of whether I will be able to resist the temptation to put it in "scare quotes") both I and people who know what they are talking about doubt that much public money will be saved via this bill.
I think it would be good policy to allow the medicare administration to exclude FDA approved drugs from its formulary (to not pay for them). However, it is clear that a bill to that effect will opposed by Pharma with adds in which an elderly actor and actress discuss how he is going to die because they can't afford a drug and medicare won't pay for it. Thus the bill would have to be carefully drafted. I (finally) get back to my suggestions.
The bit about liability for physicians sounds really fun but might be a way to get the AMA allied with Pharma and might not be a good idea. Maybe a sense of the house (or senate) resolution is too much and this should just be a talking point for individual policy makers and sympathetic commentators. The key thing is that people be convinced to blame their physician not congress when they get stiffed with the bill.
The point of my proposal is to make the threat of exclusion from the formulary as non frightening as possible to medicare beneficiaries while still scaring Pharmaceutical companies some. Plan D.2 will cost more than a program where a single bureaucrat can exclude an FDA approved pharmaceutical from the formulary but compromise is both good policy and necessary politically. If Democrats gain control (win the White House in 2008) it will be possible for the medicare administration to make an example of a pharmaceutical company with attendant bad publicity for both per encourager les autres to cut prices.
I'd say I have an idea which will save the US treasury billions while discouraging pharmaceutical companies from wasting R&D on copy cat drugs.
Update: Oh damn forgot to take my meds (this is literally true)