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Future Clinical Guidelines to Look Closer at Healthcare Costs — Physician’s First Watch

Medical News |
April 22, 2014

Future Clinical Guidelines to Look Closer at Healthcare Costs

By Kelly Young

Guidelines from medical groups may increasingly consider the cost of treatments in addition to their effectiveness, the New York Times reports.

Some of the examples mentioned in the article include the following:

  • The American Society of Clinical Oncology is designing a scorecard to help physicians look at the cost, value, efficacy, and side effects of various treatments. It should be available by fall.

  • The American College of Cardiology and the American Heart Association will begin using information on cost from published studies to help evaluate treatments in future guidelines.

  • Seventeen guidelines issued by 30 physician specialties in 2013 integrated economic data, an increase from a decade ago.

Reader Comments (1)

ELLEN LERNER Other

The NYT article was EXCELLENT. I wish I could read all the comments there that were also well stated. When it comes to prescriptions there is this policy now called
"step therapy" which is a misnomer far as I am concerned, designed to curb the cost of prescribing medications (therapy for the insurance company:} however it also overrides a physicians decision to go with a certain drug (better therapy for the patient,) and it often ignores what the patient needs. Yes one can appeal a committee decision, but I am finding the first step to request an expensive drug is no. I am specifically referring to prescription treatments for MS. I am also specifically talking about a drug called Copaxone 20mg/day which on avg. costs almost $5000/mo. Now there is a new rollout of this drug called Copaxone 40mg 3x/week. My physician requested this drug for me and I wanted it because I can inject it 3times a week not 7. Who wouldn't want this? First trip around, REJECTED by some committee for the drug companies. Now I will appeal but it is complicated in that next month I'll no longer be on employee based health insurance and also because the original 20mg drug is supposedly going generic (which I hear may come out soon, but I have my doubts.) Either way from what I read so far, the newer version is about the same if not a little less in cost and I do think I was refused because the ins. co thinks the one I take now will soon be generic. Reasons given to me so far I don't find valid and will appeal again assuming my doctor agrees and after my new ins. card comes. However it is not about what is best for the patients it is about cost alone. What I see is this same insurance company that takes out HUGE ads in the paper and pays their retiring (and probably current) CEO's huge amounts money that could help many many people everywhere or keep the costs of these medications down. And I agree with the NYT article that how this is all handled is very anger producing in patients lke myself. I certainly don't know how drug companies work, but I'd like to know why these drugs are so expensive. Yes I know about research and social benefit to those who cannot afford it , but even so some of it makes no logical sense to me. I heard about that a newer pill form for MS (and there are other newer ones) taken twice a day and doesn't require refrigeraton or over night delivery with ice packs, etc. but costs about $4000 more than the injectable drug. I just don't get it. Some docs like mine prefer not to use it for reasons that the pill form has not been around long enough to prove itself. I wonder how likely ins. companies will allow that one that is easier to take and ship but costs a lot more? And why does the ins. co. have such power over what a physician thinks a patient needs? Why don't the drug companies work more with the ins. companies to get the cost down and approved? Why even come up with new drugs if the cost and ins. approval is an issue?

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