• Why prescription drugs cost so much more in America | Financial Times

    En dehors de celles pour « la recherche et le développement » (R&D) d’un médicament, quelles sont les autres dépenses d’une compagnie pharmaceutique ?

    Major #pharma companies make about twice as much in profit each quarter as they spend on R&D. And most spend significantly more on sales and marketing — particularly in the US, where TV advertising is allowed.

    The industry is also spending more money on M&A and share buybacks. Increasingly, #big_pharma is outsourcing innovation to smaller biotechs, then buying the companies before they have a product on the market and using their own commercial machines to sell the drugs widely.

    When they are not buying companies, they are often buying back shares. Unlike dividends, buybacks boost earnings per share, helping executives meet targets and bag bonuses. From 2006 to 2015, 18 major pharma companies spent $261bn on buying back shares, 57 per cent of what they spent on R&D, according to William Lazonick, a professor of economics at the University of Massachusetts Lowell.

    He says the drug companies and their lobbyists “are talking out of both sides of their mouth”. “Either the purpose of a drug company and the people managing it is to take the profits and reinvest them . . . to do drug development. That I have no problem with,” he says. “Or it is to distribute money to shareholders, which is in fact what they are doing.”

    • Même avec toutes ces dépenses, le prix des médicaments devrait être beaucoup plus abordable (sans empêcher des profits raisonnables) ; pourquoi ce n’est pas le cas ?

      All over the world, drugmakers are granted time-limited monopolies — in the form of patents — to encourage innovation. But America is one of the only countries that does not combine this carrot with the stick of price controls.

      The US government’s refusal to negotiate prices has contributed to spiralling healthcare costs...


      Missing from the US landscape are authorities such as the National Institute for Health and Care Excellence (Nice) in the UK or the Patented Medicine Prices Review Board in Canada, which negotiate prices and consider value for money.

      De plus, comme le fait remarquer l’économiste US Dean Baker, cette absence de contrôle des prix qui permet des marges faramineuses incitent à mettre sur le marché des produits inefficaces, sinon délétères : exemple de l’oxycontin.

    • Le refus du gouvernement étasunien de contrôler les prix est d’autant moins justifié que l’argent public joue un rôle énorme dans la découverte des médicaments :

      ... the biggest single funder of innovation in the US remains the government. In 2017, the US National Institutes of Health spent more than $32bn on research, compared with an estimated $71bn from all the members of PhRMA, the major pharmaceutical industry lobbying association.

      D’autant plus que des lois existent, qui permettent à l’état étasunien d’intervenir en faveur de la fin des monopoles quand de l’argent public a été dépensé,

      The government can do this both because it has general authority to compel licensing of patents (with reasonable compensation) and because it has explicit authority under the 1980 Bayh-Dole Act to require licensing of any drug developed in part with government-funded research. The overwhelming majority of drugs required some amount of government-supported research in their development, so there would be few drugs that would be exempted...

    • Même assuré, un malade n’est pas sur de pouvoir se payer ses médicaments quand le système « déductible » entre en jeu (le prix du médicament n’est couvert qu’à partir d’un certain seuil, seuil qui peut signifier le déboursement de plusieurs milliers de dollars par le malade). D’autant plus que, paradoxalement (mais non mystérieusement*), ce ne sont pas les produits les moins chers que les assurances choisissent de couvrir...

      Pharmaceutical companies point the finger at the pharmacy benefit managers who work for insurers. Each insurer has a list that shows which drugs it will pay for and in what order. Pharma companies want to be at the top of the list, so they pay rebates to PBMs to ensure good placements. The money is split with the insurers.

      The drugmakers argue that rebates are the problem. They say that list prices look high but are rarely what an insurer or patient pays. People do pay list price, however, if they are uninsured, and they pay a proportion of it if their plan has co-insurance, requiring them to pay, for example, 20 per cent of prescription costs.

      On the journey across the border, patients who have never met before share similar war stories of battling with insurance companies. Hunter Segos’s insurer refused to cover his insulin when he used a discount card the pharmacist had given him to try to make it cheaper.

      Odette’s husband’s insurer will not pay for the type of insulin that her doctor says she needs, so she has to take other medicines to compensate for side effects. “I can get the insulin I was supposed to be on for three years for the first time today,” she says.

      * Why Do Americans Pay More for Drugs ? by Robin Feldman - Project Syndicate

      At the center of the system are “pharmacy benefit managers” (PBMs), who represent health-insurance plans in drug-price negotiations with pharmaceutical companies. Because health insurers pay PBMs based on the discounts they secure, these intermediaries should in theory try to negotiate the lowest possible drug prices for their clients. But in practice, established drug companies offer PBMs financial incentives to favor their higher-priced drugs and block cheaper competitors.