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Perspective
Volume 359:333-335 July 24, 2008 Number 4
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Tier 4 Drugs and the Fraying of the Social Compact
Thomas H. Lee, M.D., and Ezekiel J. Emanuel, M.D., Ph.D.

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The growing number of biologic drugs for cancers and other serious conditions is a harbinger of things to come — in more ways than one. These drugs demonstrate that basic research into mechanisms of disease can lead to innovative treatments that turn fatal conditions into chronic disorders. But recent headlines about their high costs — often $50,000 to $100,000 per year — serve as warnings about the financial and ethical challenges we will increasingly encounter throughout medicine.

Because of the rising number of such high-priced medications, some insurers have begun to revise their tiered drug-copayment structures, which have generally delineated . . . [Full Text of this Article]


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Dr. Lee is network president at Partners Healthcare System, Boston, and an associate editor of the Journal. Dr. Emanuel is the chair of the Department of Bioethics, National Institutes of Health, Bethesda, MD.


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