Are guidelines a smokescreen for cost containment?
A greater fear among manufacturers is that plans will employ formulary guidelines as a means to contain costs under the banner of quality improvement. Although manufacturers might complain that guidelines impose bureaucratic hurdles, impede access to important new drugs, and dampen incentives for innovation, experience suggests that explicit consideration of evidence tends to increase rather than decrease spending, because it sheds more light on under- rather than overtreatment.27 Drug spending in Australia grew after the country implemented its pharmacoeconomic guidelines, for example.28 The NICE process has tended to “level up” access to pharmaceuticals.29 After Oregon implemented its prioritization scheme, its Medicaid spending rose faster than other states’ Medicaid spending.30 Drug companies may not like the hassle and uncertainty that come with new guidelines, but they should not expect a negative impact on overall sales. The larger challenge for champions of formulary guidelines
