The only reason to require drug evaluation is as an exercise in central planning. There are other ways to structure insurance programs to make them sustainable, to protect patient preference, and to protect the prescribing rights of physicians; that way is simply to make patients responsible for some of the costs at the point of service, through a deductible, which is normal insurance design, or through utilization-based premiums, for instance. Even with a community-based premium--one that is flat--everybody pays the same rate. It is a much different way of structuring a drug program than tax-based redistribution of financing. The only reason we have to engage in the central planning exercises of drug evaluation is because of the nature of our drug programs.
Secondly, I would say that those jurisdictions that have engaged in restricting access to drugs have not shown great achievements in cost constraints. In fact, B.C. introduced quite massive deductibles, twice changing the deductible by a range of $200 and dramatically reducing eligibility for benefits under their program in the process. That is where they achieved their cost savings. In fact, some of the prices of the drugs they were dealing with changed over that time, and even in the United States, they became lower. So all of the supposed cost savings in the B.C. model are really illusory. In fact, we've seen the same evidence from other jurisdictions, such as New Zealand, which has tried similar approaches.
I think the third and most important point is that restricting access has an impact on patient health outcomes. Let's face it, we're not all genetically the same; we don't all need the same drug product. We are trusting our physicians as our health care agents, and in conjunction with my physician, I would like to have my right to make those decisions for myself protected.
I just think if we go at this from a different angle and we look at a proper way to structure our insurance programs, we'll end up with a better result.