The tough decisions that no one wants to make.

This article examines prescription drug benefit plan trends: past, current, short-term future and long-term future. It includes a brief discussion of each cost trend and its drivers, then asks the question, "What can be done to protect the pharmacy benefit budget, yet provide what is needed?" from three perspectives: (1) business, (2) stakeholders (management, human resource groups, physicians, employees) and (3) patients (employees and dependents). The article discusses therapeutic guidelines, physician education, reimbursement issues, distribution channels and the impact of business decisions on employees, dependents, stockholders, shareholder value, management, human resources and decision makers' own careers.