Christopher
Holt April 10, 2020
At the
start of 2020, reducing the prices American patients pay for prescription
medications was at the top of the health care priority list for federal
policymakers. The coronavirus pandemic sweeping the globe has significantly
shuffled the deck on policy priorities. Now, if prescription drugs are on
the agenda at all outside of coronavirus-related treatments and vaccinations,
it’s in the context of the global supply chain.
It’s
ironic that as a result of the pandemic, Congress and the Trump Administration
appear more likely to take action actually increasing the costs of
pharmaceuticals than bringing them down. There is growing momentum among
lawmakers for “Buy American”
provisions broadly, and to make changes to the pharmaceutical supply chain
specifically in the name of safety, security, and preventing shortages.
One
driver of this push is growing discomfort with China. I’m sympathetic to
concerns about the threat China poses to America’s national and economic
security, but in the case of the pharmaceutical supply chain, our
dependence on China may be overstated. Eric Boehm of Reason recently
published a good explainer on
how we don’t really know how much of the ingredients for our drugs—active
pharmaceutical ingredients (APIs)—actually come from China. We do,
however, know that
only 13 percent of API manufacturers supplying ingredients for drugs sold in
America are based in China. That’s less than the 18 percent based in India, 26
percent in Europe, or the 28 percent based here in the United States. It would
be useful to know—and the Coronavirus Aid, Relief, and Economic Security Act
does include provisions aimed at shedding light on—exactly what percentage of
the APIs supplied to the U.S. market come from China and elsewhere, but it is
apparent now that the global supply chain for U.S. drugs is actually quite
diverse.
Of
course, for some policymakers the diversity of the supply chain is a problem in
and of itself. The “Law of the Instrument” is a familiar concept: When all you
have a is a hammer, everything looks like a nail. In the current political
context, you can reframe that idea and reverse it: When you believe that
globalization is at the root of every problem, then protectionism is your only
tool. Back in those halcyon days of late January, when many still believed the
coronavirus to be primarily a Chinese problem, Commerce Secretary Wilbur
Ross explained that
the coronavirus pandemic could have the positive effect of increasing U.S.
employment because companies will have to consider the risk of a global supply
chain.
We’re all
familiar now with the current state of employment in
United States. Far from a problem, the diversity of the global supply
chain provides some measure of security. Having API suppliers all over the
world allows for manufacturers to shift procurement when circumstance require.
If the supply chain is more localized, it’s also more likely to be impacted by
natural disasters or outbreaks like the coronavirus. Additionally, and here’s
the rub, manufacturing APIs overseas is often cheaper, resulting in lower
prices in the United States. In 2011, the Food and Drug Administration found that
“bulk manufacturing in India can reduce costs for U.S. and European companies
by 30% to 40%.” Any move to force pharmaceutical manufactures to shift
their supply chains to the U.S. will absolutely lead to increases in the cost
of medications for American patients. Further, it takes years and substantial
investment to set up manufacturing facilities. Onshoring the U.S.
pharmaceutical supply chain wouldn’t be quick, even if it were desirable.
Having a
full and data-driven discussion of the safety, security, and sustainability of
the pharmaceutical supply chain would be helpful. These issues should be explored,
and there is a dearth of useful data. Changes to the existing supply
chain, however, must be approached with caution and should not be part of the
immediate response to the pandemic. Policymaking in a crisis should be limited
to matters directly relevant to and aimed at resolving the immediate
challenge. Broad and far reaching policy shifts in a moment of uncertainty
and panic are likely to do more harm than good.
FROM TEAM HEALTH
Daily Dish: Recent Trends in Insulin Prices – AAF
President Douglas Holtz-Eakin
Rising insulin prices certainly affect diabetics, but the effects are felt more broadly, too.
Rising insulin prices certainly affect diabetics, but the effects are felt more broadly, too.
Taking the Voters’ Pulse on Pharmaceuticals – Douglas
Holtz-Eakin
AAF’s recent polling on voters’ attitudes toward various drug-pricing policy proposals provides a valuable guide to an issue that will doubtless re-emerge in the future.
AAF’s recent polling on voters’ attitudes toward various drug-pricing policy proposals provides a valuable guide to an issue that will doubtless re-emerge in the future.
Daily Dish: A Look Back at Pressing Health Policy Issues – Douglas
Holtz-Eakin
Voters’ preferred approach to reforming drug pricing is re-designing Medicare Part D to make it more affordable and put downward pressure on prices.
Voters’ preferred approach to reforming drug pricing is re-designing Medicare Part D to make it more affordable and put downward pressure on prices.
WORTH A LOOK
Kaiser Health News: Newsom’s Ambitious Health Care Agenda
Crumbles In A ‘Radically Changed’ World
Health Affairs: Integrating Health And Human Services In
California’s Whole Person Care Medicaid 1115 Waiver Demonstration
https://www.americanactionforum.org/weekly-checkup/the-global-drug-supply-chain/#ixzz6JWFtGWKL
Follow @AAF on Twitter
Follow @AAF on Twitter
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