title: An ethical template for pharmacy benefits.
abstract: We propose an ethical template for pharmacy benefits and a fair process for using it. The template delineates four levels of decisions about pharmacy coverage, connecting ethically acceptable types of rationales for limits with decisions made at each level. It provides a framework for organizing ethically relevant reasons for coverage (or the tiered copayments). The process for using the template assures accountability for the reasonableness of benefit decisions. It requires transparency and relevance of rationales for limit setting and revisability of decisions, including through fair procedures for appeals. The template and the process facilitate broader public learning about fair limit setting.
authors.affiliation: Harvard School of Public Health, USA.
authors.forename: Norman
authors.initials: N
authors.lastname: Daniels
authors.forename: J Russell
authors.initials: JR
authors.lastname: Teagarden
authors.forename: James E
authors.initials: JE
authors.lastname: Sabin
mesh_terms: D003657:Decision Making; D018954:Drugs, Essential / Q000008:administration & dosage / Q000145:classification* / Q000191:economics*; D004989:Ethics; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000941:ethics; D015276:Health Care Rationing / Q000191:economics / Q000941:ethics*; D006292:Health Priorities / Q000941:ethics; D006801:Humans; D019458:Insurance Coverage / Q000941:ethics; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000941:ethics*; D010879:Piperazines / Q000191:economics; D011687:Purines; D040841:Resource Allocation; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000191:economics; D000068677:Sildenafil Citrate; D013450:Sulfones; D014481:United States
chemical_list: D018954:Drugs, Essential; D010879:Piperazines; D011687:Purines; D017367:Selective Serotonin Reuptake Inhibitors; D000068677:Sildenafil Citrate; D013450:Sulfones