PANORAMA US pharmaceuticals have enjoyed their time in the sun, but is it time to get out the umbrellas?
Despite having the highest healthcare expenditure of all industrialised nations (17.1% of GDP in 2013), the US public health outcomes are being outperformed by other advanced nations. Back in 2010, the introduction of the Affordable Care Act (ACA) (1) was designed to correct these shortcomings, in particular by increasing health insurance coverage. Yet beyond this question of coverage, cost has become a crucial issue. Households are finding that the high price of medicines is becoming prohibitive. This has led to a rising call for reform (especially during the presidential campaign). A drop in prices would certainly affect the bottom line of the companies working in this sector, especially the laboratories who would be forced to review their operations and cut back on research D and development (R&D) spending.
US pharmaceuticals have enjoyed their time in the sun, but is it time to get out the umbrellas?
A COUNTRY THAT SPENDS A LOT OF RESOURCES ON ITS HEALTH, BUT LACKS EFFICIENCY
1.1. Medicines even more expensive than in Europe
The price of medicines has risen sharply in the USA in recent years. Gleevec (leukaemia) cost 270% more in 2015 ($118,000/year) than in 2011 ($31,930/year). The cost of Januvia (diabetes) rose from $146/month in October 2006 to $213 in December 2013 (+46%), and $331 in January 2015 (+55%). One good example was the decision taken by Pfizer Inc. in January 2016 to implement a massive 20% price hike for 100 of its drugs.
But it's not just the cost of drugs that is an issue, and one study conducted by the International Federation of Health Plans in 2013 showed that the cost of hospital services is also high. The authors in fact found that the USA charged more than every one of the comparator countries (2) . The cost of an angioplasty or bypass is nearly twice as much as in New Zealand or Australia. The same applies to diagnostic imaging techniques (e.g. scans). The average cost of a hospital stay in America is $18,000, whereas in Canada, the Netherlands and Japan, it ranges between $4,000 and $6,000.
Contrary to other advanced nations, the law prohibits the country's biggest buyers, such as Medicare(3) , from negotiating prices directly with the drug companies. In the USA, it is the pharmaceuticals that set the price, as opposed to the European States where the price is set by the healthcare system. Prices are generally higher in America than in advanced countries, despite the fact that US insurance companies give discounts for a large number of drugs. According to Langreth et al. (2015) (4) , of the eight top-selling medicines in advanced countries, seven were more expensive in the USA, even after discounts
The drug companies justify these high prices by high R&D spending ($50 billion in 2014, 0.3% of American GDP) and a relatively short-lived global patent protection (12 years before generic versions can be produced)
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