"When an ICE is only marginally better, might an HMO be negligent not to permit its use?"
That is doubtful, especially if it is only marginally better as opposed to significantly better, or shows a significantly better clinical outcome. According to Peter's article, "advocates of newer drugs" should at least show they are "equivalent, preferably superior to the older agent, in a "randomized comparative trials" Some classes of drugs (statins) require a large sample and long follow-up." I doubt if any of Sepracor's drugs would require long clinical trials as they probably chose not to pursue those ICE's.
Now cars are a different story. The courts have decided that our cars definitely need the more expensive OEM parts, not the gray market parts or generics. "The prevailing legal theory was that State Farm knew that gray market parts were not as good. I wonder if State Farm's defense included data from controlled randomized tests demonstrating no significant differences in the parts they used?
I know that generics are not as good as brand drugs, but my insurance company only pays for generics; if a generic is availble, I have to pay for the brand myself.
BTW, the group of lawyers planning on suing the HMO's call themselves the "Repair Team." The lawyers include Richard Scruggs, and Ronald Motley, and the firm of David Boies, the lawyer who currently is representing the government in the antitrust case against Microsoft Corp. |
