Thread by @mariliacout

1 / Prescription drug cost and price: let's dissect this problem. Prescription drug prices are rising. There's consumer discontent on one side, pharmaceutical companies explanations on the other and the government apparently badly informed by experts.
bit.ly/2Su0XUw

2 / The first thing to understand is that there are two radically different cost and price types of drugs: those under patent protection and those beyond the 17 years of USPTO patent protection.
nature.com/articles/nrd12…

3 / With costs rising up to almost one billion dollars per molecule and around a decade of research and development to reach that, the company has 17 years to cover the cost of R&D and profit from it (keep going: I'm not done).
bit.ly/2WDP7q8

4 / Here is a nice image explaining how it works and the link to the article

discoverymedicine.com/Michael-Dickso…

5 / What happens after the 17 years of patent protection? Simple: anyone can produce the drug. Because (1) the R&D innovation cost has been payed off and (2) there is corporate competition, the actual cost falls. It decreases orders of magnitude.

6 / @AOC is right when she claims a critical part of the drug innovation costs are paid by government (taxpayer money) organizations because that is how tech-transfer works:
haas.berkeley.edu/faculty/papers…

7 / Still, the cost of development remains high - too high to keep pharmaceutical corporations profitable during patent protection if the prices don't cover their investment and the profit margin. Two approaches there: 1. generic drugs; 2. lowering the cost

8 / There are two main approaches to this problem: cutting the total innovation cost and making wise use of generic drugs.
csmres.co.uk/cs.public.upd/…
archives.who.int/prioritymeds/r…

9 / Generic drugs should be very cheap, correct? Why aren't they in the United States (twice the average price of the rest of the world)? Because the USA has granted government-protected monopolies to drug manufacturers.
preview.thenewsmarket.com/Previews/JOUR/…

10 / Physicians who try to help their patients by prescribing equally effective generic drugs are now seeing these patients unable to follow treatment
annals.org/aim/fullarticl…

11 / We have two new problems now: (1) physicians are not sufficiently up to date on new drugs and their benefits and fall prey to the manufacturer's marketing, prescribing unnecessarily expensive drugs instead of an equally effective cheaper alternative.

12/ and (2) the Drug Price Competition and Patent Restoration Act of 1984, or the Hatch–Waxman Act, which regulates generic drugs, might be under violation:
bit.ly/2BjhAIF

13 / Some scholars question the patent system itself as a driver of technological innovation and economic development. While I don't agree with them, they have been here for a while
pubs.aeaweb.org/doi/pdfplus/10…

14 / Drug prices/cost are just one tiny aspect of the huge American health care system crisis. I hope to have shown that there is no economic reason for generic drug prices to increase or even to remain high. There is no explanation for the cost of insulin, for example.

15 / The solution is not simple. Actually, the solution is so complicated that it is possible that a new system will have to be "invented". American politicians romanticize universal health care as if it was just a magic wand bill approval (keep reading).

16 / It is not. Countries that offer universal public health care also control health providers. That means that big, strong hospitals are also State-owned, there is strong regulation over health insurance companies (which become complementary-only), among other measures.

17 / The USA has public hospitals, but they are not as strictly regulated as it would be necessary to ensure a real universal public health system.
beckershospitalreview.com/lists-and-stat…

18 / Bottom line: (a) we need to enforce generic drug regulation; (b) expand public hospitals and public hospital beds; (c) strictly insurance. I haven't seen this approach in any politician's platform. That makes us, @TheDemocrats, vulnerable to criticism.

19 / @DemWrite , I'm thinking of contributing an article on this. What do you think?

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