Evaluating Research Results for Commercial Applications

A managed care health plan has the policy that it will not pay for any treatment if a less costly intervention would achieve identical results.  Noting that clinical trials generally compare new and often expensive drugs and treatments only to a placebo, may the health plan decline to pay for any such new intervension until additional research has shown it to be more effective than less expensive or generic alternatives?  Or, must the health plan accept self-servings opinion of industry researchers, even when their clinical trials do not address the relative effectiveness of alternative treatments?

5S replies:  The practice of comparing a new intervention with a placebo, while ethically correct from a research perspective, rarely produces negative results.  It tells little about the relative benefits versus available alternatives and nothing about the cost-benefit tradeoff.  Nonetheless, before declining to pay for a new drug or treatment, the health plan must show that the innovation is less effective than existing alternatives, perhaps by comparing the results of different clinical trials that measured the effectiveness of each against a placebo.