Thread by @PeterKolchinsky

Here's an ALMOST GREAT explainer of why drugs cost more in the US than other countries. The one thing I would change is to reverse the logic of who subsidizes whom. Many think US subsidizes other countries' access to medicines. But in truth...

...other countries pitch in for cost of funding the drug industry to make drugs Americans need, reducing America's costs. We can wish for those countries to pay more, but it would be counter-productive to deny them access unless they pay more...

...b/c European countries are willing to deny their citizens access to new medicines & so they might just end up paying nothing at all. Trump's strategy of demanding US drug prices=EU drug prices, as with many things, is akin to threatening to cut off our nose to spite our face.

In this case, the nose is EU's contribution, however modest, to funding the drug industry's operating costs by buying branded drugs for somewhat lower prices than in the US (~20-40% lower).

And the face is the status quo, where Americans get new medicines and EU pays less than its fair share to also get them. Of course, what all this is about is achieving affordability for patients, which is a function of insurance.

Patients in EU can afford medicines they need not b/c those medicines are cheaper there but b/c EU patients pay little out of pocket. Consider... if a drug costs $20k, would cutting it to $12k make it affordable to most Americans w/o insurance or who have a $6000 deductible? No!

In fact, whether the drug costs $20k or $12k, to the patient w/American insurance it still costs $6k... the amount of the deductible. So for Americans to afford the medicines they need, they need insurance reform.

And if our government can negotiate with other countries to get them to pay more for branded drugs, that's great - it would either add more fuel to innovation or reduce America's share of paying for the innovation that Americans want. That's good either way.

In the meantime, the whole world can take heart in fact that drugs offer great value b/c they go generic, unlike anything else in healthcare. Hospitals don't... Doctors don't... which is what's driving up healthcare costs relentlessly.

But generic statins, for example, spare Americans and Europeans and people all over the world from having heart attacks, keeping them out of hospitals, averting pain, death, and wasteful spending on ER visits, hospital stays, and surgery.

Statins were expensive once, now not, & they keep saving us money on services. That's the major value proposition of drugs and almost NO ONE is talking about it. But Congress knows... at least the people who drafted the Hatch-Waxman Act and work on its amendments (like @JoeBiden)

The key drug/insurance reforms America should be focused on are achieving affordability by lowering out of pocket costs for patients and making sure America gets value for what it pays for branded drugs by making sure that all drugs go generic without undue delay.

And let's make sure that all countries pitch in for the cost of innovation at least what they are willing to, even if it's less than they can, because some help funding new medicines is better than none.

If you want America's government to appreciate the value of biomedical innovation and to implement the right reforms to make medicines affordable for all Americans, then we need more scientists in Congress, like chemist @ngoroff in NY. goroffforcongress.com/issues

I've written more on how to make medicines affordable and what prudent drug pricing reforms would look like here. If you don't read the book, there are many short articles on related issues. thegreatamericandrugdeal.com