US formulary management in a crowded market place
The US have long been the safe haven for pharmaceutical companies to reap the rewards for their investment in bringing a drug to market, as opposed to the increasing downward pressure on pricing and reimbursement seen in Europe. However, in recent times some disease areas have become saturated with relatively undifferentiated therapeutics and this has allowed pharmacy managers and managed care organisations to take advantage and negotiate greater discounts. In exchange, some products are receiving preferred formulary status, and those that have not offer discounts have been threatened with exclusion from the preferred lists.
The US continues to circle the subject of outright price control measures like those seen in Europe. However, it is becoming increasingly apparent that budget holders in the US are seeking to peg back drug costs and limit the use of expensive medicines to ever-narrower populations. This has been seen in Oregon, where there is intention of limiting expensive hepatitis C treatments to only patients who face severe liver damage without the drug, rather than anyone diagnosed.