Here’s a little mental exercise to play with:
We do a huge part of our prescription business in mental health medications. Some of these brand name meds are quite expensive and I would like to focus on aripiprazole, aka Abilify, for this thought experiment. Abilify is indicated as an adjunct or “add-on” therapy in the treatment of depression. There are a couple studies showing that it is more effective than placebo when added to existing SSRI, such as Zoloft or Paxil) or other therapies such as bupropion. Patients report both success stories and miserable failures when taking Abilify. Half of the package insert is a discussion of side effects and adverse reactions. In my opinion this is a drug of some moderate usefulness, high cost, and very significant risks.
One of the state behavioral health plans covers Abilify, and interestingly insists on brand name. I can only assume that some sort of rebate to the plan is in place. Otherwise, why spend more of the taxpayers’ money than is necessary? The monthly cost of Abilify is about $1,000 per month. Abilify is often used to boost the therapy of a depressed patient. So I postulate: If we have a depressed patient, being treated with moderate success with one or two generic agents, and we are considering adding Abilify, why wouldn’t we consider another choice? I would suggest that the taxpayers could be well-served by simply giving the patient $500 cash each month! If I were moderately depressed and on a state welfare plan, $500 per month might be a huge factor in changing my life and lifting my depression. An extra $500, with continued counseling, could change my life in ways far beyond the power of a pill like Abilify. I doubt the plan is getting a 50% rebate, so $500 likely saves the taxpayers plenty of money. Even if the stipend was $300, there would be a noticeable and positive on that patient’s life and lowered taxpayer cost.
I, for one, would rather see my cost reduced and my taxes dollars be used in more insightful and innovative ways. Obviously this is just the nugget of an idea and needs refinement but don’t be afraid to consider this kind of out of the box thinking when it comes to recreating health care.
Think about it.