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- Page navigation anchor for RE: Should national pharmacare apply a value-based insurance design?RE: Should national pharmacare apply a value-based insurance design?
Public money should not be used to pay for prescription drugs of little to no medical value. To the extent that value-based insurance design (VBID), whereby drugs of lower medical value attract a higher copay, advances this proposition it is an idea that has merit (1). However, there are also significant problems with VBID that should give policy makers cause for concern.
First, is the question about how to determine value. In some cases, it is relatively easy to assign value, e.g., insulin for Type 1 diabetics is clearly a valuable drug. But in other instances it is more difficult. As a 71 year-old man, I place a high value on using an alpha blocker because it allows me to sleep through the night without needing to get up and urinate. Where would alpha blockers fit into a VBID system? If they were deemed low value, after all they are certainly not life saving or even life extending, and had a high copay attached to them, then I might not be able to afford them and my quality of life would not be as good.
More importantly, is the question of who is being penalized under a VBID system. Ideally, a prescription should be the result of a negotiation between the prescriber and the patient, but in reality most patients accept the decision of the prescriber that a particular medicine is necessary for their health. Unless, we accept the notion that patients demand a prescription for a low value medicine and the prescriber acquiesces to that demand, it is the clinicia...
Show MoreCompeting Interests: In 2016-2019, Joel Lexchin was a paid consultant on two projects: one looking at developing principles for conservative diagnosis (Gordon and Betty Moore Foundation) and a second deciding what drugs should be provided free of charge by general practitioners (Government of Canada, Ontario Supporting Patient Oriented Research Support Unit and the St Michael’s Hospital Foundation). He also received payment for being on a panel at the American Diabetes Association, for a talk at the Toronto Reference Library, for writing a brief in an action for side effects of a drug for Michael F. Smith, Lawyer and from the Canadian Institutes of Health Research for presenting at a workshop on conflict-of-interest in clinical practice guidelines. He is currently a member of research groups that are receiving money from the Canadian Institutes of Health Research and the Australian National Health and Medical Research Council. He is member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare. He receives royalties from University of Toronto Press and James Lorimer & Co. Ltd. for books he has written.