1000 tier formulary?

As if 3-tier drug formularies weren't confusing enough, there is a new movement toward "benefit-based co-pays," or BBCs. Under a BBC, the patient's co-pay is determined by the drug's clinical benefit. The more beneficial the drug, the lower the co-pay. In certain cases, the patient can even be paid to take the medicine.According to a Healthcare Intelligence Network survey, BBCs are catching on. Thirteen percent of respondents have already implemented them and another 10 percent plan to do so in 2006.This is my first exposure to BBCs and I'm not yet persuaded. One of the arguments for BBCs is to reduce the confusion from multi-tier co-pays, but BBCs just seem to take that logic to an extreme, with potentially a different tier for every drug, or even for every patient for every drug. Do we really have a sufficient evidence base for each drug and situation to make BBCs worthwhile? And who is going to explain all this to patients when they come to pick up their prescriptions?