The Washington Post had an article about plans by Louisiana to stop paying for Hepatitis C drugs for its Medicaid and prison populations by the dose. Instead, it will take bids from drug companies on how much they would charge for a year of unlimited use of their drugs.
While this will still allow the companies to make large profits on their sales to the state, it has the great benefit that eliminates the enormous gap between the price of the drug and the marginal cost of producing an additional dosage. In the case of Hepatitis C drugs, this gap was enormous. The list price for the drug Solvaldi was $84,000. The cost of producing a high-quality generic version is a few hundred dollars.
For $84,000 it is necessary to think carefully about whether a Hepatitis C patient should get the drug, given the enormous expense involved. At a few hundred dollars, cost really is not an issue. This change in payment structure will allow Louisiana to provide much better care to people in the state suffering from Hepatitis C.
Hopefully this model, which is similar to the prize system that many have advocated, will be adopted for other drugs and in other states. I have argued that paying for the research upfront is a better route since it will allow full openness in research and test results, but the Louisiana system is undoubtedly an enormous step forward from the current system. (This paper discusses the merits of different routes.)