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This article compares the pharmaceutical pricing policies employed by public and private insurers in the United States with seven price and spending control strategies employed in the United Kingdom, France, and Germany. Differences between American and European policies explain why American pharmaceutical prices and per capita spending are higher than in European nations. The article then analyzes two recent bills as examples of significant American reform ideas--H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act (introduced in 2019) and the Build Back Better Act (BBBA, introduced in 2021)--and compares them with European cost control strategies. Key drug price provisions of the BBBA were incorporated into the recently enacted Inflation Reduction Act (IRA). H.R. 3 would have used an international (mostly European) price index to cap U.S. prices, the BBBA would cap Medicare prices at a discount from average U.S. market prices. Neither bill would employ the key cost control strategies that European nations do. Both bills would have significantly less impact on prices than legislation that employs European-style cost controls. This article proposes steps that Congress could take in line with European strategies to lower purchase prices and costs for patients. These measures would have to overcome political obstacles that currently stymie reform. [ABSTRACT FROM AUTHOR]

This article explores the impact European Union (EU) integration has had on methods and processes of budgeting in France and Britain from 1970 to 1995. It assesses whether convergence of budgetary institutions occurs and, if so, whether it is promoted by an obligation of compliance or by an hybridization effect. Compliance refers to changes in national budgetary institutions made compulsory by membership in the EU. Hybridization emphasizes that national and EU budgetary processes are increasingly interwoven and indivisible. Public budgeting is no longer purely national because part of the decision-making on national expenditure is made at the EU level and because the national budget is closely linked to the EU budget in financial and policy terms. Based on an institutional analysis, combined with elite interviewing, the article suggests that hybridization is a significant factor contributing to a convergence of budgetary practices in Britain and France. Underlying the argument is the fact that an increasingly important function of departmental actors involves negotiating with their EU counterparts at the EU level, in addition to the conventional budgetary game at the domestic level. Regarding compliance, there is an influence as testified by significant formal institutional convergence. However, compliance seems a less effective factor in influencing convergence than hybridization because it conveys a "negative" approach to convergence, based on enforcement and sanctions. The article suggests that the convergence of administrative systems is promoted by the growing similarity of administrative practices more than by the harmonization of rules. [ABSTRACT FROM AUTHOR]