There are some more backroom deals going on that may or may not help patients. As a physician, I know why some insurance companies cover certain drugs while others are "off formulary" or are "third tier". Pharmaceutical companies and the managed care companies play Let's Make A Deal to see which drugs they will cover or not and then send out nice little letters to the patients informing them that their doctors are prescribing medications that are way too expensive for them. The patient then comes a callin' and we switch from one drug to another until the next round of deals occur and we start all over again. It is the medical version of the circle of life. Now, according to a NYT article, is a new spin to that circle. Merck is going to peg what they charge Cigna for their meds Januva and Janumet depending how well it brings down a patient's glycohemoglobin. Proctor and Gamble and Sanofi Aventis will do the same thing with their osteoporosis drug Actonel; this time reimbursing for any fractures that occur. This sounds all fine and dandy but I am not so sure. It is still backroom deal making and the patients are playing the guinea pigs. Are these same patients getting anything out of this other than Actonel and Januvia are now on formulary? Recent studies are also showing that too tight a diabetes regimen may not always be in the best interest for the patient. Now that Cigna will be spying hard on our charts, I wonder what their true interest will be - the HbA1C or the patient? I don't know the answer to these questions but I do know that everyone loves the "pay for performance" concept (except me) so expect more of these deals to happen soon.