>The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy
Unknown to almost everyone in the US is that if you are a Medicare patient, when you go to fill a Rx before the pharmacist fills the therapy, insurance software suggests cheaper generics to the pharmacist and requires the pharmacist to do the leg work of asking the doctor to change the Rx based on what the insurance company wants (ie the cheaper medication).
So the question might be..why would a pharmacist do what the insurance company software tells them... or why would a doctor second guess their initial Rx at the request of an insurance company trying to minimize their costs? Because if the pharmacist/pharmacy doesn’t do what insurance says or if the doctor doesn’t do what insurance says, they get dropped from the insurance network.