Lowering Cost and Increasing Access to Drugs Without Jeopardizing Innovation

April 23/30, 2019, Vol 321, No. 16, Pages 1547-1642

Lowering Cost and Increasing Access to Drugs Without Jeopardizing Innovation
Robert M. Califf, MD; Andrew Slavitt, MBA
[Initial text]
US drug costs have reached unacceptable and unsustainable levels. Evidence shows that “financial toxicity” arising from drug costs and other medical expenses is reducing financial security for many families1 and prompting difficult choices, as patients defer or forgo therapies they cannot afford.2 In stark contrast, comparable countries negotiate drug prices and use drugs more effectively. Recent data suggest that other high-income countries have an average life expectancy approximately 3 to 5 years longer than that of the United States, which ranks last among high-income countries and is losing ground compared with peer nations.3 Although drug prices account for only part of these trends, they nevertheless add to disparities that dominate the trajectories of US health outcomes.
An effective policy solution to this problem must satisfy the core requirements of reducing drug costs and increasing access to beneficial drugs, while continuing to incentivize development of new therapies. The path forward requires a sustainable, fair payment system in which drug prices reflect the value provided and reward innovations that improve outcomes. Four Viewpoints in this issue of JAMA47 recommend different but overlapping approaches for achieving these goals…