How have costs of managed prescription drug programs evolved over the past two decades, and how pervasive are managed pharmacy programs in the U.S.?

How have costs of managed prescription drug programs evolved over the past two decades, and how pervasive are managed pharmacy programs in the U.S.?
Pharmacy costs are rising in excess of general and medical cost inflation, leading to calls for price and utilization controls by public and private payers. Such controls would be ineffective and counterproductive because they would attempt to reverse two profound, historic phenomena at work in the U. S. health care system. The added costs associated with breakthrough medicines represent a major structural shift from the provision of traditional medical services to the consumption of medical products; they also represent the creation of economic, social, and public health utility that we value as a society. The balkanization of medical delivery, institutionalized under traditional reimbursement strategies and galvanized by federal law, does not adequately account for or efficiently accommodate this rotation and increased utility. Federal and state laws regulating health insurance and provider risk sharing need to be revamped to encourage rather than constrain the social progress embodied in expensive, breakthrough medical technologies.
Many drugs pay dividends to the U.S. health care system that far exceed their costs.
The U.S. health care system in the new century is rife with good and bad news, both stemming from the same source: medical innovation. First, the good news: Overall life expectancy and health status in the United States are improving; infant mortality is declining; and disability rates among the elderly have been falling nearly three times as fast as they did over the previous decades
 
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