Drug coverage plans should be separated out and be all-the-patient-needs.
Doctors should not have to haggle for a drug for a patient.
The patient co-pay should be approximately the incremental manufacturing cost.
Each drug plan should cover about 80% of the patented key molecules, 80% of the breakthrough drugs and 80% of the recombinant drugs, at a minimum.
Drug plans would typically buy entire product line access from most drug companies for their insureds.
For drugs not covered, they would have to be available via a federal program with up to college FAFSA level patient pricing (with federal subsidies up to EU pricing). If Mr. X can pay $2000 a year to send Junior to college, Mr. X can pay $2000 a year for a drug to save his life.
Drug makers would have an incentive to have their drugs in at least one drug plan (which might be their own).
Drug plans would be sold nationally.
To get a federal subsidy, a doctor who has previously treated you would have to approve your plan choice. This is to ensure you buy a proper plan that will meet your needs.
Remember, drugs are primarily expensive because of the federal patent system and federal FDA.
Also hospitals push the latest greatest most recent (no track record) drug before it gets recalled. There are other drugs which do the same thing but they've gone generic and hospitals don't get bonuses for pushing generic drugs.