In the course of a board review program I've been reviewing ten years of medication development ...
... I've long had an information-geek's admiration for the printed version of Monthly Prescribing Reference. Despite its evil ad-funded roots, there's a real genius to the density and layout of the content, refined by generations of customer feedback. It also has the virtue (and sin) of being always topical and exceedingly brief.
So I started my review by reading this cover to cover. Each time I come across a medication that's new to me, or a familiar one that unlocks a domain of forgotten knowledge, I add it to my core med review sheet. This sheet is also an interesting overview of what's changed in medicine over the past decade. There was more activity in the treatment of Parkinson's Disease, for example, than I would have guessed...
Other than observing the desperate attempts to find something Tumor Necrosis Factor inhibitors are good for, I was struck by the explosion of combination meds.
What explains this? Is it patient demand? Is it pharma desperation due to a shrinking development pipeline?
It was Emily who suggested a motivation that could explain the development all by itself.
The most common co-pay schemes strongly incent patients to minimize the number of their chronic prescriptions, with much less incentive to minimize the cost of prescriptions. On the other hand, combination meds are very profitable for pharmaceutical companies.
I suspect the payors who designed co-pay schemes didn't have have these outcomes in mind.