Search

Importance: The increasing cost of prescription drugs in the United States has become a source of concern for patients, prescribers, payers, and policy makers.Objectives: To review the origins and effects of high drug prices in the US market and to consider policy options that could contain the cost of prescription drugs.Evidence: We reviewed the peer-reviewed medical and health policy literature from January 2005 to July 2016 for articles addressing the sources of drug prices in the United States, the justifications and consequences of high prices, and possible solutions.Findings: Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index. In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations. In the United States, prescription medications now comprise an estimated 17% of overall personal health care services. The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents. The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies. The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors, including the requirement that most government drug payment plans cover nearly all products. Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available at different costs. Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear.Conclusions and Relevance: High drug prices are the result of the approach the United States has taken to granting government-protected monopolies to drug manufacturers, combined with coverage requirements imposed on government-funded drug benefits. The most realistic short-term strategies to address high prices include enforcing more stringent requirements for the award and extension of exclusivity rights; enhancing competition by ensuring timely generic drug availability; providing greater opportunities for meaningful price negotiation by governmental payers; generating more evidence about comparative cost-effectiveness of therapeutic alternatives; and more effectively educating patients, prescribers, payers, and policy makers about these choices. [ABSTRACT FROM AUTHOR]

Examines the frequency, importance, and potential implications of research-related gifts from companies to academic life scientists. Context; Objective; Design; Setting; Participants; Main outcome measures; Results; Conclusions.

Editorial. Considers sharply differing views of research taken by university researchers and the company that is sponsoring the research, if the company's product is at stake. Details on trial of a drug called Synthroid from Boots Pharmaceuticals Inc. at the University of California; Lessons to be learned for university researchers and faculty, the companies involved, the Food and Drug Administration, professional societies, and journals.

A response from authors of the article "Cost-related motivations for conducting research: Participants should be informed," is presented.

Discusses a report from the Institute of Medicine (IOM). Need for broader public understanding of the way the United States National Institutes of Health (NIH) allocates its research funds; Details on the report, `Scientific Opportunities and Public Needs; Improving Priority Setting and Public Input at NIH'; Committee hearings on the way the NIH sets priorities.

A letter to the editor is presented in response to the article "Cost-related motivations for conducting research: Participants should be informed," by R.K. Nayak and colleagues.