Lifestyle drugs: determining their value and who should pay.

Lifestyle drugs are used to alleviate or enhance: (i) lifestyle problems or conditions, regardless of the cause; and (ii) health problems for which the underlying cause is in the realm of personal responsibility. It is the particular use of a drug, rather than its inherent properties, that determines whether it is called a lifestyle drug. The increasing availability of, and high demand for, lifestyle drugs contributes to their expanding role in healthcare. In the absence of objective pharmacoeconomic data, the subjective value or cost effectiveness of these agents varies among patients, medical professionals, regulatory agencies and payors. Most nations rely on value systems that are implied, rather than clearly articulated. The aims of largely institutional payors, and the individual patients and their physicians do not always coincide, creating tensions over who should pay for these drugs. Cost-sharing between patient and payer, drug limitations and prior authorisation protocols are some methods used to manage access to these drugs. There is an urgent need to formulate coherent values, priorities and strategies for dealing with lifestyle drugs. To do this, local and national regulatory agencies, politicians, healthcare providers, insurers and patients need to formulate broad areas of consensus. Finally, we must not forget compassion for the patient as we apply the dictates of institutional policy.