Tier 4 Drugs and the Fraying of the Social Compact

Abstract

The growing number of biologic drugs for cancers and other serious conditions is a harbinger of things to come — in more ways than one. These drugs demonstrate that basic research into mechanisms of disease can lead to innovative treatments that turn fatal conditions into chronic disorders. But recent headlines about their high costs — often $50,000 to $100,000 per year — serve as warnings about the financial and ethical challenges we will increasingly encounter throughout medicine.Because of the rising number of such high-priced medications, some insurers have begun to revise their tiered drug-copayment structures, which have generally delineated . . .