Question normal

We are currently rationing access to medications through what health plans decide to pay for, step therapy, drug tiers, prior authorization, etc. There is a balance between creating an appropriate sense of moral hazard and being cost prohibitive, and we are veering towards the latter, with up to 1 in 4 Americans not filling prescriptions due to cost, often in ways that do not make sense for providing the best, most cost-effective care. Hillary's healthcare plan wants to require insurers to cap out of pocket drug spend at $250 per month. In looking at her plan, this is only for FDA approved drugs for a specific indication (e.g. not off-label drugs). One concern I have immediately is that around 40% of prescriptions are for off-label indications. I think in most cases, insurers do not cover off-label drug use (including Medicare)? A recent paper discussed that off-label use is not going away any time soon, and the FDA won't likely have a good solution for this given the rapid expansion of medical knowledge. How does off-label prescribing factor into patient drug cost exposure and current utilization tools used by payers? What solutions exist/should be pursued?