The laser-like national focus on reining in the cost of certain prescription drugs is beginning to produce thoughtful responses from all parties, although the pharmaceutical manufacturers may be less than enthusiastic about much of the activity.

Among the most ambitious: a proposed new rule by the Centers for Medicare and Medicaid Services that would test different ways of managing the cost of very expensive drugs based upon performance criteria. It targets drugs that are distributed either in physicians' offices or at hospitals, ones that tend to be expensive.

CMS wants to alter both the percent it pays out for Part B drugs for Medicare patients, and experiment with payments based upon "value-based purchasing tools similar to those employed by commercial health plans, pharmacy benefit managers, hospitals, and other entities that manage health benefits and drug utilization."