Pitfalls in Linking Cost Sharing to Value

  1. R. Scott Braithwaite, MD, MSc; and
  2. Allison B. Rosen, MD, MPH, ScD
  1. From Yale University School of Medicine, Veterans Affairs Connecticut Healthcare System, New Haven, CT 06516, and University of Michigan School of Public Health, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48109-0429.

    IN RESPONSE:

    We thank Dr. Polsky for highlighting several substantive issues. Reference pricing (that is, paying the price of only the cheapest drug within a class of similarly effective drugs) is only 1 among many ways to link cost sharing to value, and it also only concerns drugs within a particular class. We endorse an approach that is sufficiently flexible to address a broad range of drug and nondrug clinical alternatives.

    We recognize that cost-sharing decisions may be plagued by accusations of caprice and conflict of interest, and …

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    1. Ann Intern Med February 5, 2008 vol. 148 no. 3 244
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