For example, a major investment by the NIH into research on HIV in the 1980s certainly could be viewed as an important foundation for the many antiviral drugs that have subsequently been developed.
If that decision is not overturned by the United States Supreme Court, generic versions of the drug in controversy, Norvasc (amlodipine besylate) will be available much earlier.
To be approved for sale a product must demonstrate that it is generally safe (or has a favourable risk/benefit profile relative to the condition it is intended to treat), that it does what the manufacturer claims and that it is produced to high standards.
[4] Once a regulatory agency has determined the clinical benefit and safety of a product and pricing has been confirmed (if necessary), a drug manufacturer will typically submit it for evaluation by a payer of some sort.
Structures like the UK's National Institute for Health and Clinical Excellence and Canada's Common Drug Review evaluate products in this way.
If necessary, a drug plan may negotiate a risk-sharing agreement to mitigate the potential for an unexpectedly large budget impact due to incorrect assumptions and projections.
As mentioned, formularies may be used to drive choice to lower cost drugs by structuring a sliding scale of co-payments favouring cheaper products or those for which there is a preferential agreement with the manufacturer.
This is usually done to limit the use of a high cost drug or one that has potential for inappropriate use (sometimes called 'off-label' as it involves using a product to treat conditions other than those for which its license was granted).
These patient populations, often called 'medically needy,' may have all or part of their drug costs covered by 'plans of last resort,' (typically government-sponsored).
The government-sponsored program provides a specified list of essential drugs to primary care clinics in low-income neighbourhoods.
Similarly, Brazil provides drugs for HIV/AIDS free to all citizens as a deliberate public health policy choice.
Co-payments may be used to drive certain prescribing choices (for example, favouring generic over brand drugs or preferred over non-preferred products).
Prescribing may be limited to physicians or include certain classes of health care providers such as nurse practitioners and pharmacists.
In settings such as hospitals and long-term care, pharmacists often collaborate closely with physicians to ensure optimal prescribing choices are made.
In some jurisdictions, such as Australia, pharmacists are compensated for providing medication reviews for patients outside of acute or long-term care settings.
Pharmaceutical policy may also subsidize smaller, more marginal pharmacies, using the rationale that they are needed health care providers.