What is Fair? Choice, Fairness, and Transparency in Access to Prescription Medicines in the United States and Australia

Abstract

The importance of prescription drugs to modern medical practice, coupled with their increasing costs, has strengthened imperatives for national health policies that ensure safety and quality, facilitate affordable access, and promote rational use. Australia has made universal and affordable prescription drug coverage a priority for decades, within a policy framework that emphasizes equity and increasing transparency in coverage design and payment decisions. By contrast, the U.S. lacks such a national policy. Furthermore, federal Medicare reforms aimed at making appropriate drug coverage affordable and accessible employs two icons of the U.S. perception of fairness--the right to choose and the right to challenge coverage design limits--that mask the limited nature of the assistance. As the U.S. seeks to impose its values and priorities on other nations through the negotiation of bilateral and regional trade agreements, it becomes important to consider the two national experiences, in order to avoid trading illusory notions of fairness for true population equity.