The Great Drug Rebate

"As you pass through life, my friend, may this always be your goal: keep your eye upon the doughnut, and not upon the hole."

OK, it's not Shakespeare, but that pithy saying sums up my philosophy of "learned optimism." I choose to focus on the doughnut, not the hole. And a healthy dose of optimism, whether or not it comes naturally, will be essential for the health-care reform process to bring forth an end state that truly delivers on the promise of a healthy and productive populace at a cost we can afford to bear. It is essential that we continue to focus on the really terrific stuff we do have going for us in the U.S., and build upon it.

New drug discovery is one of those important activities we seem to do really well. The ability of the U.S. pharmaceutical industry to continue to innovate must be preserved. And the recent announcement that drug manufacturers will either pay a rebate to Medicare or offer 50 percent discounts to seniors who fall into the Medicare Part D "doughnut hole" coverage gap is both significant and laudable. But let's not kid ourselves: the pharmaceutical companies have plenty of cushion to concede the $80 billion discount that they have collectively placed on the table.

Continuous learning, continuous quality improvement and continuously innovating for value must be the mantras by which we undertake reform. Fixing the Medicare prescription benefit anomaly is an important step to take in reforming health care. Why not take it one step further? How about if, instead of merely treating all drugs as though they provided equal benefit, we provided incentives to reduce barriers for our seniors (for all folks, really) to be adherent with those therapies that are consistently shown to be of the highest value? How about giving away generic statins and ACE inhibitors to our elderly diabetics? My gut tells me that when the time comes to debate comparative pharmaceutical effectiveness it's got to be as much about incentives and behavior change as it is about efficacy, side effects and cost.

By Raymond J. Zastrow  |  June 22, 2009; 3:32 PM ET  | Category:  Health Care Reform , Pharmaceutical Companies
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