First off, let’s agree on two basic concepts: capitalism is good and patient safety is good. For decades we have been tempted with a never-ending parade of new, expensive devices and medications that are touted to improve safety and outcomes. Sometimes the acquisition cost is justified, and sometimes it’s not. Fortunately our clinical experience, common sense and pharmacoeconomic literature generally help us to determine when global value exceeds (or at least meets) cost. We perform a cost/benefit analysis and provide the best care for our patients using appropriate resources. In other words, we provide value-based care based on sound economic principles.

Recently we have found ourselves in a position where previously safe and affordable medications have skyrocketed in price, forcing us to make difficult choices, with potential implications for patient safety. The seemingly obvious truth that generic medications are...

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