By Joyce Frieden
MedPage Today, March 23, 2021
“All over this country, the American people are asking a simple question: How many people need to die before Congress is prepared to take on the greed of the pharmaceutical industry?” Sen. Bernie Sanders (I-Vt.), chairman of the Senate Health, Education, Labor & Pensions (HELP) Subcommittee on Primary Health and Retirement Security, said during a subcommittee hearing Tuesday on the high price of prescription drugs.
As to what Congress should legislate, Sanders had three ideas, embodied in bills he had introduced: Pegging U.S. drug prices to those of other industrialized countries; allowing for reimportation of prescription drugs from other countries; and allowing Medicare to negotiate drug prices. “Every other major country on earth … negotiates drug prices, and the time is long overdue for Medicare to do that as well,” he said.
“Why Does the US Pay the Highest Prices in the World for Prescription Drugs?”: Testimony of Dr Nav Persaud, Canada Research Chair in Health Justice and Associate Professor, University of Toronto
United States Senate Subcommittee on Primary Health and Retirement Security, March 23, 2021
Canada regulates the price of patented medicines and pays less for the same medicines
In Canada, per capita drug spending is $879 versus over $1,229 in the United States. Per capita drug spending is about 40 % higher in the United States largely because of the regulation of patented drug prices by the Canadian Patented Medicine Prices Review Board.
Posted prices for patented medicines are approximately 3 times lower in Canada. The Patented Medicines Prices Review Board is slated, in July, to drop the United States from its list of comparator countries used to set “price ceilings”, because prices are shockingly high in the United States compared with other high‐income countries including the United Kingdom.
Change is possible with political will
Pressure and lobbying by the pharmaceutical companies (and private insurers) have undermined reforms in both Canada and the United States. Multiple government reports over decades have recommended including medicines in Canada’s public single‐payer system to improve fair access and to save billions each year.vii But this has not happened, so we continue to pay higher prices than comparable countries such as New Zealand and Australia and inequities persist. America is a superpower that has not shown its strength in standing up to pharmaceutical companies that rip off Americans, as proven by the price differences for patented medicines across our border.
Three ways America – the superpower – can lower drug prices
- Punish abusive pricing of patented medicines by creating a new Bureau. Create a new Bureau to set price ceilings for patented medicines, give that Bureau the resources and teeth to keep prices low, and empower that Bureau to issue compulsory licences when companies price patented medicines unreasonably. The new Bureau should be able to cut annual drug spending by at least $100 billion.
- Use negotiating power and open tendering processes to secure low prices on a defined set of essential medicines as per international guidance. Negotiating power can help to ensure equitable access to needed medicines including off‐ patent or generic medicines.
- Use existing legislation, and additional political will, to discipline the companies currently bloated by high medicine prices that illegally market products. There is a need for urgent action – Americans are getting ripped off by more than $100 billion each year and, in the wrong hands, this money is used to illegally market medicines in ways that kill Americans.
While some get rich, others die. Cost‐related non‐adherence to medicines – not taking pills as instructed due to the cost – is more common in Canada (8%) and the United States (17 %) than in comparable high‐income countries where it is typically below 5 %. The Centers for Disease Control and Prevention estimated that all‐cause mortality was 15 % to 22 % higher among Americans with chronic diseases such as diabetes who cannot afford their medicines compared with those who could afford them. Drug pricing is a life and death issue.
Comment:
By Don McCanne, M.D.
We often look to Canada as a possible source of lower-priced pharmaceuticals. But Canada – a nation with one-tenth of our population – can hardly serve as the source of our medications that is ten times their own need. Besides, Canada continues to struggle with its need for a Pharmacare program to serve its own people. But that does not mean that they do not have good advice for us.
I happened to have been prescribed recently a long-term medication that is priced at over $500 per month. Although I have insurance under Part D Medicare, it was designed by conservatives to be certain that the patient bears a significant portion of the costs. So I am one of those made to “feel the pain” so that maybe I’ll decline this important and perhaps life-saving medication. (Just a small example of the difference between conservative and progressive health policies – individual responsibility versus collective social good wherein individuals frequently do not have the same negotiating leverage as would our government working for us all, while still providing the medical-industrial complex with fair margins.)
The solution is simple. The United States government needs to use its negotiating power in the purchase of drugs. As part of a single payer Medicare for All, everyone could have the drugs they need in a system that is affordable for all.
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