J Russell Teagarden1, Norman Daniels, James E Sabin. 1. Clinical Practices & Therapeutics, Medco Health Solutions, Inc., 100 Parsons Pond Drive, Franklin Lakes, NJ 07417, USA. russell_teagarden@medcohealth.com
Abstract
OBJECTIVES: To present an ethical framework that could aid prescription drug benefit design and to propose that such a framework could be organized around a benefit allocation hierarchy. SUMMARY: Four hierarchical levels of allocation are proposed, as follows: (1) drug categories and subcategories, (2) individual drugs within covered drug categories, (3) specific indications of covered drugs, and (4) special features of drug use, such as quantities covered for specific indications. Rationales for decision making should address the distinct ethical issues apparent at each level. CONCLUSION: Ethical issues associated with designing and managing a pharmacy benefit can be identified by using a hierarchical prescription drug allocation scheme. Articulating these issues is an important first step toward arriving at a fully developed framework that will serve to produce rationales acceptable to typical stakeholders in prescription drug benefits.
OBJECTIVES: To present an ethical framework that could aid prescription drug benefit design and to propose that such a framework could be organized around a benefit allocation hierarchy. SUMMARY: Four hierarchical levels of allocation are proposed, as follows: (1) drug categories and subcategories, (2) individual drugs within covered drug categories, (3) specific indications of covered drugs, and (4) special features of drug use, such as quantities covered for specific indications. Rationales for decision making should address the distinct ethical issues apparent at each level. CONCLUSION: Ethical issues associated with designing and managing a pharmacy benefit can be identified by using a hierarchical prescription drug allocation scheme. Articulating these issues is an important first step toward arriving at a fully developed framework that will serve to produce rationales acceptable to typical stakeholders in prescription drug benefits.