US report studies drug reimbursement options

The New England Journal of Medicine has published a perspective piece looking at the health insurance coverage structure for biologic drugs. The report, titled, Tier 4 Drugs and the Fraying Social Compact, examines the approach taken by some health insurers to deal with the high cost of the more expensive biotechnology drugs, particularly for cancer.

Instead of the more familiar co-payment, where a patient is charged a flat fee for certain types of procedure, co-insurance is proposed. This means that the patients is charged a share of the drug's cost. The study's authors Thomas Lee, an NEJM associate editor, and Ezekiel Emanuel, chairman of the department of bioethics at the National Institutes of Health, describe the approach to holding down premiums as "politically feasible." However, the NEJM article goes on to advocate a rationing system for treatment coverage, based on cost and effectiveness.