The healthcare systems in Germany and the United Kingdom are examples of systems that are able to manage costs while improving access to medications; however, it is unlikely that the US will follow these models, explained Gerard Anderson, PhD, of Johns Hopkins Bloomberg School of Public Health.
Transcript (slightly modified)
What is being done in other countries to improve access to medications? Can the US use these as a model?
There are a lot of things that we could do, but very few things that we probably will do. There are 2 systems that we really should take a look at very closely. The first one is in the UK and it’s called NICE, and the second one is in Germany—they’re similar, but different.
The easiest one to understand is NICE in the UK, and what they do is they say if a drug, or if a device, costs more than about $40,000 per quality-adjusted life year—a poor life year, to make it a little simpler—they will pay for it. If you charge more than that, we’re not going to buy it. Now a drug company knows, "well, if I price it at $39,999, I’m going to get it covered, and if I price it at $50,000, I’m not going to get it covered." So, you’ve told them exactly what they’re going to do.
Germany does something very similar to that, but not exactly the same. It makes some more adjustments for the type of disease that you have. It essentially says if you have cancer, or something like that, we might pay a little bit more than if you have diabetes. It’s all based upon, historically, how much we spend for that particular drug to treat you.