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The issues of appropriateness, compliance, cost-effectiveness, patient selection and symbiosis (ACCESS) are vital to both health care and pharmaceutical industries and define their possible relationship. "At this moment, Medicare’s rules – yes, the same Medicare that’s slated to go broke in a decade or so – forbid it to consider cost in its coverage decisions.
Why doesn't Dr. Jones' opinion about therapeutic efficacy really matter? What if the patient won't or can't take the test or medicine? Why, in the calculus of health care quality assessment isn't medication compliance, affordability, taste, frequency of dosing, or even opportunity costs* taken into account when insurance companies decide what to pay for or to cost-share? For that matter why don't these issues weigh in on public policy and health-care reform?