Who Wrote The Medicare Formulary?

I've seen lots of articles lamenting the doughnut hole in Medicare's drug benefit, but nary a one complaining that seniors can't get the drugs their doctors prescribe. Amazing, isn't it? No one seems to have a single complaint that the drug plans, generously reimbursed by the federal government, are seeking to hold down costs by prohibiting people from buying pricey me-too drugs.

What's up? Have physicians and their patients suddenly wised up and said, no thanks, now that the government is paying the tab, I'll go for the generic?

A small clue as to what is going on is contained in the Annals of Internal Medicine that hits physicians' desks tomorrow morning. Physicians who wrote the Medicare drug purchasing guidelines (the so-called formulary) review how they went about their business.

In 2003, Congress told the Center for Medicare and Medicaid Services (CMS) that it should contract with the U.S. Pharmacopeia to draw up model guidelines for Medicare Part D formularies. The U.S. Pharmacopeia, for those not familiar with the organization, is a freestanding non-profit outfit headquartered across the street from the Food and Drug Administration in Rockville, Md. It sets standards for all prescription and over-the-counter medicines, dietary supplements, and other healthcare products manufactured and sold in the U.S. Like many standards-setting groups, it derives most of its revenue from industry, which has an interest in having an objective, outside party create a level playing field for their competition.

But as a go-between government and industry, especially when government is now ponying up somewhere around $60 billion a year for drugs, one has to wonder just how objective they might be. Do they have the interests of taxpayers at heart, the patients or their major clients?

I don't have access to the Annals, so I'd be curious to learn how they made their decisions. But the abstract distributed on the Internet had a most intriguing conflict of interest disclosure. The guidelines, the disclosure assured readers, were written "according to USP's strict rules regarding conflict of interest."

Did those "strict rules" limit who sat on the 17-member committee? Turns out one physician on the committee worked for Caremark, which offers a Medicare Part D prescription drug plan; another provided health economic consulting to pharmaceutical companies and received an educational grant from Merck; there was a Pfizer employee on the list, who, it was dutifully disclosed, also owned stock in J&J; a Pfizer consultant who provided advice to pharmacy benefit managers also wangled his way onto the committee; while another industry consultant reported he received grants from Wyeth, AstraZeneca, Merck, and Pfizer.

And we're supposed to feel reassured that this was a group looking to hold down costs?

Posted by gooznews at September 18, 2006 08:56 PM