Nice article, reprinted from the Wall Street Journal - States, Insurers Find Solutions for Drug Costs describes succesful strategies for decreasing drug costs.

After a heart-attack scare, Ms. Hummel, 55 years old, visited her Kaiser Permanente clinic in Santa Clara, Calif., for a cholesterol check. Her readings weren't good: Her LDL, or bad cholesterol, was 195, nearly twice her recommended level. She got a prescription for a type of drug called a statin. Within a month, her LDL had fallen to 104.

It's the kind of outcome you'd expect from Pfizer Inc.'s Lipitor or Merck & Co.'s Zocor, two heavily advertised pills that are the top-selling statins. But Ms. Hummel took lovastatin, a generic version of a drug called Mevacor that Merck introduced in 1987. It's less potent than the others and has been largely ignored by company marketers since Zocor came out a decade ago.

But Mevacor, which went off patent last year, is plenty powerful for most patients. It is now the linchpin to an ambitious cholesterol-management program in Kaiser's Northern California Division. More than 80 percent of the division's 130,000 high-risk heart patients have reached federally recommended cholesterol goals, up from 22 percent five years ago. And, thanks to the drug's lower price and Kaiser's discount-generating purchasing power, the HMO can treat five patients with lovastatin for what it costs to treat just one with Lipitor.

Point well made! This is not an isolated example in the article. The problem remains educating physicians (including myself) on clinically proven alternatives. We hear more about the newer medications, and often forget the older ones. Where are the studies showing equivalence?

In the U.S., the FDA scrutinizes drugs for safety and clinical effectiveness, but no federal agency offers a comprehensive assessment of the economic value of drugs. Many private health plans attempt such research while creating their lists of approved drugs, but those data largely remain secret.

The National Institutes of Health, which conducts and finances basic research, sponsors occasional clinical trials comparing the performance of drugs. In 1994, the NIH's National Heart, Lung and Blood Institute launched a 44,000-patient trial to compare, among other things, four hypertension medications. The institute wanted to know which was more likely to prevent heart attacks and deaths.

Results of the study aren't expected until late this year, but already it has yielded an important finding. Patients taking a blood-pressure medication called doxazosin were more likely than those on a cheaper diuretic to have heart problems and be hospitalized for congestive heart failure. That prompted a call by the Heart, Lung and Blood Institute for one million Americans taking doxazosin to see their doctors about using an alternative.

But the NIH sponsors relatively few such studies, which are complex and costly. Increasingly, experts argue that the government should play a more active role in exploring the cost-effectiveness of drugs. ``We have a national institutute for heart disease, a national institute for diabetes, a national institute for allergies,'' says Harris Berman, chief executive of Tufts Health Plan in Waltham, Mass. ``Maybe we need a national institute for pharmacy.''

I have previously decried the lack of these practical and important studies. As long as we rely on pharmaceutical companies to fund research on their drugs, we will not get the studies that we need!