One of the biggest issues that faces healthcare is grappling with the onslaught of high-priced biotech drugs. That's one of the key focuses at the World Congress' executive forum on Rx Benefit Management underway in San Francisco. And the attendees here got an earful from Regence Blue Shield of Idaho's vice president of pharmacy, Terry Killilea. Killilea is a strict advocate of evidence-based medicine, and says that payers have got to pay strict heed to scientifically relevant data in making formulary decisions if they plan to avoid getting swamped by a tidal wave of specialty drug costs. Killilea sees too many drugs showing up on formularies that haven't been tested in trials that compare the effect of the drug against a placebo. He believes that kind of randomized drug trial is the only legitimate approach.
Killilea wants more systematic reviews that compare all the data from all the trials regarding a drug. It's a rare approach in the payer world, but if it catches on it could require more of the big pharma companies to keep their eye on the science of drug discovery. Too many studies, such as the one on antidepression cited below, stray from the kind of evidence-based approach that more and more payers are likely to demand before it provides coverage. On the other hand, an over-strict adherence to data may well prohibit plan members from obtaining the drugs they need. It's not an easy line to draw, but more and more payers seem perfectly willing to take the heat in light of the costs. That's a trend developers can't ignore. - John Carroll