He’s vowing to take on drug prices
at home — but they could go up abroad.
By SARAH KARLIN-SMITH and SARAH WHEATON
05/09/2018 05:05 AM
EDT
President Donald Trump wants Americans to get lower prices for
medicines — and the rest of the world may pay for it.
His "America First" message on drugs at home, coupled
with pro-pharmaceutical industry policies abroad, could lead to higher costs
for patients around the world — without making drugs more affordable for those
in the U.S.
Trump on Friday plans to deliver his long-promised speech on how
to lower drug costs, addressing an industry he has in the past accused of
"getting away with murder." Global health officials worry he will
also target practices that keep medicines affordable in other countries.
Amid rising trade tensions between the U.S. and key trading
partners, Trump and top administration officials have repeatedly blamed high
U.S. prices in part on foreign countries that take advantage of the significant U.S. investment in
medical research without paying their fair share. Many nations,
including wealthy European ones, negotiate or regulate drug prices to keep them
lower than what Americans typically pay.
“As part of President Trump’s bold plan to put American patients
first, HHS is focused on solving a number of the problems that plague drug
markets, including … foreign governments free-riding off of American investment
in innovation,” Health and Human Services Secretary Alex Azar recently said.
He added that high drug prices can leave crucial medicines out of
reach.
“There's little difference for a sick patient between a miracle
cure that hasn't been discovered and one that is too expensive to use,” said
Azar, a former executive at Eli Lilly, which has received its share of
criticism for raising the price of medicines, including insulin.
Foreign governments and international advocates are struggling to
reconcile Trump’s dual messages. He is making a populist call for
affordability, but at the same time U.S. diplomats have been defending the
industry’s prerogatives more than ever in trade negotiations and international
gatherings.
Many European experts view the policies he is crafting on trade,
patents, transparency and intellectual property rights as advancing the drug
industry’s interests overall, affecting rich and poor nations alike.
The United States can’t unilaterally change the sticker price on
drugs abroad, but Trump’s administration can create a climate in which they are
likely to rise.
“It’s hilarious. Trump is a businessman, and every businessman
knows you charge what the market will bear,” said Suerie Moon, of the Global
Health Centre, Graduate Institute of International and Development Studies in
Geneva. “It’s a line that we have heard from [pharmaceutical] lobby groups,
that if European countries would pay more, that would be a fairer situation,
but I’ve rarely heard companies argue if Europe paid more, the U.S. pays
less."
Trump’s policies may play out in trade pacts like a revised NAFTA agreement, which is currently being negotiated, or in global forums like the World Health Organization, which will take up drug pricing at its May 21 annual meeting. WHO has nearly 200 member countries, but the U.S., which provides about a quarter of its budget, holds outsize sway.
Poorer countries have long struggled to pay for the latest drugs,
but nowadays even richer Western European nations feel the pinch of five- and
six-figure price tags on treatments for diseases like hepatitis C or cancer.
“The pharma pricing issue has really come to a breaking point,”
said Ellen ‘t Hoen of the University of Groningen in the Netherlands and a
former executive director of the Medicines Patent Pool, which secures rights to
produce cheap copycats of drugs for poor countries. “There’s a real appetite
for change.”
The White House declined to comment before Trump’s speech except
to refer to the president’s past remarks and his administration’s economic
reports.
U.S. Office of the Trade Representative spokeswoman Emily Davis
said the aim is pharmaceutical trade policies that are transparent,
nondiscriminatory “and increase fair market access for American innovators.”
The White House Council of Economic Advisers issued a report in February
that labeled “free-riding” from wealthy countries ”the root of the problem.”
Some trade policies the administration has favored, like keeping
generics off the market longer than some public health experts advocate, could
actually reduce competition for pricey biologics for diseases like cancer or
rheumatoid arthritis. Delaying the marketing could also set back the emerging
biosimilar industry, meaning less access to cheaper versions of these new
therapies in the U.S. and abroad.
The Trump administration has gone after Colombia and Malaysia for
taking steps that are legal under international agreements to skirt brand drug
patents when public health needs necessitate lower-cost medicines, a forceful
maneuver known as compulsory licensing, in which a country basically voids a
patent so a cheaper generic can be made. The White House negotiated a South
Korea trade deal that opened up its market to U.S. drug-makers.
And the U.S. drug lobby PhRMA cheered Trump for an April
report from the U.S. trade office, which for the first time devoted a section
solely to pharmaceutical intellectual property rights. The list did not
ultimately include the European Union, despite PhRMA’s request that it be put
on notice ahead of proposed changes to medical IP incentives, due later this
month. However, the report did name-and-shame
more than a dozen countries — including close partners like Japan and Canada —
based on complaints about pharma patent protections.
Researchers at the Center for Health Policy and Outcomes at
Memorial Sloan Kettering Cancer Center empirically tested Trump's claim that
the high U.S. prices are required to fund research and innovation. They found
that drug companies earn “substantially more” than what the industry spends on
R&D and concluded that drug-makers have room to lower U.S. prices without
raising them overseas, and still maintain their R&D investments.
And critics say Trump’s international pharmaceutical agenda could have ramifications at home.
The “trade agenda doesn’t necessarily seem to be synced up with
the access to affordable medicines agenda,” said Jeff Francer, senior vice
president and general counsel of the Association for Accessible Medicines, a
generic drug lobby.
He notes that if a renegotiated NAFTA deal grants pricey biologics
12 years of monopoly protection, not only would Mexico and Canada
have to wait longer for cheaper copycat medicines but the U.S. wouldn’t be able
to change its own law to get biosimilars to market sooner. That 12-year
standard was put in place in Obamacare, but some Democrats have been pushing to
shorten it.
Francer also pointed out the risks in Trump’s proposal to slap
billions of tariffs on Chinese imports, including ingredients used to make
finished medicines like insulin, antibiotics and vaccines in the U.S. While
many financial analysts doubt the Chinese tariffs would have a big impact on
U.S. prices, they do worry that the U.S. could spread this policy to countries
like India that are more critical to the U.S. generic drug industry. The
administration has already criticized India for
imposing price caps on medical devices used to treat heart disease and has said
it is looking at whether to revoke special import status India gets in the U.S.
as a result.
https://www.politico.com/story/2018/05/09/trump-drug-pricing-prescriptions-514925
No comments:
Post a Comment