Reference pricing for drugs: is it compatible with U.S. health care?
To control spending on prescription drugs, health insurance systems abroad have experimented in recent years with a novel form of patient cost sharing called "reference pricing." Under this approach, the insurer covers only the prices of low-cost, benchmark drugs in therapeutic clusters that are deemed to be close substitutes for one another in treating specific illnesses. Patients who desire a higher-price substitute in a cluster must then pay the full difference between the retail price of that drug and the reference price covered by the insurer. This paper explores the difficult trade-offs that policymakers must make in designing such a system, drawing where relevant from experience abroad.
Kanavos
Panos
P
Harvard Medical School, USA. p.g.kanavos@lse.ac.uk
Reinhardt
Uwe
U
D000368:Aged; D017047:Cost Sharing / Q000331:legislation & jurisprudence / Q000379:methods*; D019049:Developed Countries / Q000191:economics; D016527:Drug Costs / Q000331:legislation & jurisprudence*; D011307:Drug Prescriptions / Q000191:economics*; D016568:Drugs, Generic / Q000191:economics; D005102:Health Expenditures; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence; D010330:Patents as Topic; D010819:Physician's Role; D011050:Policy Making; D013810:Therapeutic Equivalency; D014481:United States
D016568:Drugs, Generic