A long-term objective should be integrating drug benefits with comprehensive health coverage, the authors say. But more pragmatic, immediate steps could be taken as well. One way forward is for the Centers for Medicare and Medicaid Services (CMS) to establish and administer a default, no-frills, stand-alone plan to compete with private plans. Federal officials would negotiate prices only for the CMS plan.
"A CMS plan would require a comprehensive but closed formulary, built on transparent, evidence-based assessments of comparative effectiveness and value for money," the researchers say. This may result in limiting the number of generic or brand versions of the drug, or the number of choices within a therapeutic class, as well as limiting the indications for which a drug is reimbursed. Additionally, a CMS plan should use cost-sharing arrangements based on fixed copayments. A patient's contribution should not vary with the cost of a drug, the authors say, and beneficiaries should not have to wonder how much they will be required to pay at the pharmacy.
Source:
http://www.commonwealthfund.org/publ...?doc_id=600578 accessed 12/4/2007.
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