[Source: Health and Life Sciences Daily, Sept. 18, 2007]
The Wall Street Journal (9/18, A1, Anand) reports, "Doctors, particularly oncologists, rely on medicines approved for other diseases to try to save patients for whom all other treatments have failed. But as new medicines come to market at ever-higher prices, insurers are pushing back, limiting coverage of these drugs to only the disease for which they are specifically approved by the Food and Drug Administration -- or for which there is extensive evidence of efficacy in clinical trials." The Journal notes that insurers "have little leverage in negotiating the prices of many specialty drugs because they often extend lives and lack competition." And, according to many insurers, they must "limit use of the most expensive drugs to control healthcare costs, which are surging at a seven percent to eight percent annual rate and continue to outpace inflation." The insurers say it "makes sense" to require "proof that a drug works in a patient's particular disease before doling out tens or hundreds of thousands of dollars." Mohit Ghose, spokesman for America's Health Insurance Plans, an industry trade group, noted, "We're trying to bring new drugs to consumers, but trying to do it with employers getting the best value of every healthcare dollar spent in the system."
