Big Pharma claims lower prices means giving up miracle medications. Ignore them
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.