Big Pharma claims lower prices means giving up miracle medications. Ignore them
High U.S. prescription drug prices, exemplified by six-figure biologics for conditions like psoriasis, are weighed against claims that strong profits are needed to fund risky pharmaceutical R&D and future “miracle” treatments. Commenters debate whether Medicare price negotiations and tighter regulation would meaningfully reduce costs without harming innovation, given that much basic research is already taxpayer-funded, other wealthy countries negotiate lower prices, and pharma spends heavily on marketing and navigating complex insurance systems. The exchange surfaces deeper questions about public vs. private responsibility for drug development, how patents and monopolies shape pricing, and whether medicines should be treated more like public infrastructure than ordinary consumer goods.
High‑cost psoriasis biologics as example
- Bimzelx and similar biologics for psoriasis/psoriatic arthritis can cost six figures annually but target severe, refractory disease, often preventing pain, disability, and joint damage.
- Patients report dramatic quality‑of‑life improvements from alternatives like Taltz, but only after exhausting cheaper, riskier options; foundations sometimes cover huge gaps when insurance refuses or requires “step therapy.”
- Ads focus on “clear skin,” while commenters stress underlying degenerative, painful, and infection‑prone disease.
Insurance, formularies, and access
- Coverage depends heavily on pharmacy benefit managers and formularies; new or “tier 3” specialty drugs are often excluded or carry massive copays.
- ACA out‑of‑pocket caps only apply to formulary drugs; off‑formulary can be effectively uncapped.
- Patients may need to appeal, accept older drugs with worse side‑effect profiles, or rely on manufacturer foundations.
What drives prices? R&D, failures, and marketing
- One side argues the main cost driver is R&D plus the many failed candidates; high prices are needed to justify risky, capital‑intensive investment.
- Others counter that basic science is publicly funded, clinical trials are where private money dominates, and pharma margins ~20% limit how far prices can fall without affecting incentives.
- Disagreement over whether marketing surpasses R&D spend: some cite SG&A vs R&D ratios, others narrower ad‑spend data that show R&D still much larger.
Public funding and “socialized costs, private profits”
- Several note taxpayers fund large amounts of foundational research (e.g., NIH), while private firms capture patent rents.
- Proposals range from: government also funding expensive clinical trials and keeping publicly developed drugs non‑patent, to full public drug development funded by taxes.
- Skeptics say governments avoid full risk and don’t want to run drug production; political will is lacking.
US vs rest‑of‑world pricing
- Common claim: high US prices subsidize lower prices elsewhere where governments negotiate or cap prices; others ask what evidence would actually prove or disprove this.
- One suggestion: require companies to sell in the US at no higher net price than any other developed country, expecting US prices to fall and others’ to rise.
Medicare “negotiation” / price controls
- Critics say the Inflation Reduction Act’s scheme is de facto price control: Medicare can dictate prices under threat of broad penalties, not normal voluntary bidding.
- Cited analysis predicts several “lost” blockbuster drugs over a decade as investment falls; commenters see this as “killing the golden goose.”
- Others favor negotiation as a counter to patent‑backed monopolies and question whether innovation losses would be large or worth today’s extreme prices.
Advertising to consumers and doctors
- Direct‑to‑consumer drug advertising (legal only in US and NZ) is widely criticized as wasteful, distortionary, and contributing to overuse or brand‑switching rather than better care.
- Pharma also spends heavily on influencing doctors via reps, samples, and educational events; defenders see this as necessary information transfer, critics as targeted manipulation.
- Some argue ad budgets “pay for themselves” and thus don’t directly steal from R&D, but others see a Red‑Queen race where competing brands burn money with little social benefit.
Innovation incentives vs equity and access
- One camp: high returns are essential; lower prices mean less VC and fewer risky biotech bets, slowing future breakthroughs.
- Another camp: life‑saving and quality‑of‑life drugs should be treated as public infrastructure, funded and priced like other collective goods, with access prioritized over profit.
- Tension remains unresolved between wanting robust future innovation and broad, affordable access today.