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July 8, 2024

The crazy US pharmaceutical market

Pharma generates nearly half its global sales from the 5% of the world’s population who live in the US.

Annual revenues to Pharma per resident:

US$1,500
Europe$400

Why such a difference?

It is because:

  • in the US, pharmaceutical companies can set their prices at a level that maximizes their revenue – so they do.
  • in Europe, single payer (or regulated multi-payer) insurers are permitted to negotiate negotiate with pharma – so they do.
There are ‘problems’ with both approaches:
In the US, the market tension of a seller asking a price for its service versus a buyer paying a price for that service is there in theory, but is played out over such a complex system that it fades completely – to the point that the tension is gone and in practice, the seller sets the price.
In Europe, the (usually single payer) insurer is making decisions about the value of drugs on behalf of society as a whole, which may be at odds with the value individuals place on the drugs (though most healthcare systems allow individuals to purchase health services (including drugs) privately – and so outside the insurance system).

What is clear is that the European system results in dramatically lower pricing of drugs – and there is no evidence that European health is compromised.

It is argued that absent the high prices charged by pharma in the US market, global pharma would be a fraction of its current size and research & development (“R&D”) into new drugs would be stunted, compared to today’s levels. That is right – the world has much to thank the US for.

This is all about priorities, and the priority question may be, for the US: Social Security pensions/Medicare for retirees as promised OR continued pharma largesse/great R&D: pick one.

(or in the real world: find a middle ground)

Crunchicrant feels there is a better way that the whole pharmaceutical game can be played: society needs there to be R&D and drug testing and approvals, and resource should be lavished on those activities (extravagant fortunes made by successful researchers): manufacture and distribution – these are ordinary, low risk low return, activities. One place pharma has let society down (Purdue, Cephalon, Insys) is that distribution plays too important a role in its success.

Are we coddling far more corporate bulk than we need to? A project for Crunchicrant’s future.

(The status quo suits the industry just fine. Pharma is one of the heaviest lobbiers in Washington DC, spending nearly $1 per US resident per year – but look at the table at the head of this page. How cheap it is, to subvert the interests of the American people!)

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