Treasure Carolyn L, Avorn Jerry, Kesselheim Aaron S
Brigham and Women's Hospital and Harvard Medical School.
Milbank Q. 2015 Dec;93(4):761-87. doi: 10.1111/1468-0009.12164.
The high cost of new prescription drugs and other medical products is a growing health policy issue. Many of the most transformative drugs and vaccines had their origins in public-sector funding to nonprofit research institutions. Although the Bayh-Dole Act of 1980 provides for "march-in rights" through which the government can invoke some degree of control over the patents protecting products developed from public funding to ensure public access to these medications, the applicability of this provision to current policy options is not clear.
We conducted a primary-source document review of the Bayh-Dole Act's legislative history as well as of hearings of past march-in rights petitions to the National Institutes of Health (NIH). We then conducted semistructured interviews of 12 key experts in the march-in rights of the Bayh-Dole Act to identify the sources of the disputes and the main themes in the statute's implementation. We analyzed the interview transcripts using standard qualitative techniques.
Since 1980, the NIH has fully reviewed only 5 petitions to invoke governmental march-in rights for 4 health-related technologies or medical products developed from federally funded research. Three of these requests related to reducing the high prices of brand-name drugs, one related to relieving a drug shortage, and one related to a potentially patent-infringing medical device. In each of these cases, the NIH rejected the requests. Interviewees were split on the implications of these experiences, finding the NIH's reluctance to implement its march-in rights to be evidence of either a system working as intended or of a flawed system needing reform.
The Bayh-Dole Act's march-in rights continue to be invoked by policymakers and health advocates, most recently in the context of new,high-cost products originally discovered with federally funded research. We found that the existence of march-in rights may select for government research licensees more likely to commercialize the results and that they can be used to extract minor concessions from licensees. But as currently specified in the statute, such march-in rights are unlikely to serve as a counterweight to lower the prices of medical products arising from federally funded research.
新处方药和其他医疗产品的高昂成本是一个日益突出的卫生政策问题。许多最具变革性的药物和疫苗都起源于对非营利性研究机构的公共部门资金投入。尽管1980年的《拜杜法案》规定了“政府介入权”,即政府可以对保护由公共资金开发的产品的专利进行一定程度的控制,以确保公众能够获得这些药物,但该条款对当前政策选择的适用性尚不清楚。
我们对《拜杜法案》的立法历史以及过去向美国国立卫生研究院(NIH)提交的政府介入权请愿听证会的原始文件进行了审查。然后,我们对12位《拜杜法案》政府介入权方面的关键专家进行了半结构化访谈,以确定争议的来源以及该法规实施中的主要主题。我们使用标准的定性技术分析了访谈记录。
自1980年以来,NIH仅对5份请愿书进行了全面审查,这些请愿书要求对4种由联邦资助研究开发的与健康相关的技术或医疗产品行使政府介入权。其中三项请求涉及降低名牌药品的高价,一项涉及缓解药品短缺,一项涉及一种可能侵犯专利的医疗设备。在每一个案例中,NIH都拒绝了这些请求。受访者对这些经历的影响存在分歧,他们认为NIH不愿行使其政府介入权,要么证明该系统按预期运行,要么证明该系统存在缺陷需要改革。
政策制定者和健康倡导者继续援引《拜杜法案》的政府介入权,最近是在最初由联邦资助研究发现的新型高成本产品的背景下。我们发现,政府介入权的存在可能会促使政府研究被许可方更有可能将研究成果商业化,并且这些权利可用于从被许可方那里获得一些小让步。但正如该法规目前所规定的那样,这种政府介入权不太可能成为降低联邦资助研究产生的医疗产品价格的制衡力量。