Our expensive drugs– it’s policy choices

The latest in the Times’ excellent series on America’s absurdly inefficient and absurdly expensive health care system takes a look at prescription drugs and it’s another tour-de-force.   All sorts of good stuff in here.  I especially like that it uses the case study of the crazy situation with the common asthma drug albuterol, which after being generic for years somehow went non-generic again, thereby busting the budgets of those struggling to breathe.  Anyway, as the article makes clear in several places, this is no accident, but a direct outcome of (poor) policy choices our country has made in the realm of health care:

Unlike other countries, where the government directly or indirectly sets an allowed national wholesale price for each drug, the United States leaves prices to market competition among pharmaceutical companies, including generic drug makers. But competition is often a mirage in today’s health care arena — a surprising number of lifesaving drugs are made by only one manufacturer — and businesses often successfully blunt market forces.

Asthma inhalers, for example, are protected by strings of patents — for pumps, delivery systems and production processes — that are hard to skirt to make generic alternatives, even when the medicines they contain are old, as they almost all are…

They [pharmaceutical companies] even pay generic drug makers not to produce cut-rate competitorsin a controversial scheme called pay for delay.

Thanks in part to the $250 million last year spent on lobbying for pharmaceutical and health products — more than even the defense industry — the government allows such practices. Lawmakers in Washington have forbidden Medicare, the largest government purchaser of health care, to negotiate drug prices. Unlike its counterparts in other countries, the United States Patient-Centered Outcomes Research Institute, which evaluates treatments for coverage by federal programs, is not allowed to consider cost comparisons or cost-effectiveness in its recommendations. And importation of prescription medicines from abroad is illegal, even personal purchases from mail-order pharmacies.

“Our regulatory and approval system seems constructed to achieve high-priced outcomes,” said Dr. Peter Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center. “We don’t give any reason for drug makers to charge less.”

And taxpayers and patients bear the consequences.

And the consequences are huge.  It’s health care that’s busting our budget.  Everything else is just so much noise.  And we’re not any healthier for it!  Pharmaceutical drugs are actually a fairly small portion of our overall excess cost, but they are completely emblematic at everything that is wrong with the US health care system that drives up prices far beyond what the rest of the world pays.  It’s hard to read this article and not just be infuriated.  And deeply depressed. But read it all you should.  If nothing else, it’s got a super-cool embedded infographic on the relative cost of medicines that you really need to see.