fun tidbits from grading (medicare and expensive treatments)

every year i am re-astounded by the things we discuss about medicare in norm daniels’s ethics class. among them:

1. it is not permissible for medicare to consider cost, cost-effectiveness, cost-benefit, or opportunity cost when deciding to cover a new medicine or treatment. only effectiveness (‘reasonable and necessary’) (see D Brock 2010). this is true despite the establishment of the patient centered outcomes research institute under the ACA

2. there are no cancer drugs in the pipeline that cost less than USD 300,000/QALY (again, see Brock 2010)

3. medicare is not allowed to negotiate drug prices (as a large purchaser) with pharma companies.