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Seeking to dampen high prices for new drugs, CVS Caremark plans to allow its clients — such as health plans and employers — to exclude from their formularies any new medicine that has a higher price than a specific threshold for determining value.

Specifically, the pharmacy benefit manager set a threshold of $100,000 per QALY, or quality-of-life years, a benchmark that measures both the quantity and quality of life generated by providing a treatment or some other health care intervention. In the U.S., anywhere from $50,000 to $150,000 is used for gauging value, although $100,000 is commonly used as a threshold.


The pharmacy benefit manager will be looking to the Institute for Clinical and Economic Review, a nonprofit that runs cost-effective analyses, for guidance. Unlike other countries,  the U.S. does not have a government entity that conducts official analyses and over the past few years, ICER has increasingly filled this role, sometimes irking drug makers in the process.

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  • I guess no one is paying attention again. This is a corporate PR or advertising campaign. It is highly obvious that these corporations have corrupted science. They will merely deceive the public by appearing to be “Cost Saving.” Thanks to the lack of critical thinking occurring here and on most other sites, they will peddle this propaganda. Doing a Cost benefit analysis, sounds a lot like Healthcare rationing to me. Anything is better than looking at the root of the problem here. We need to demand fact based prescription drugs. The government should disband these monopolies, it is to late to fix this. Watch how every medical journalist educated by Pharam will sell this idea as “innovative.”

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