Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital.
Harvard Medical School.
Milbank Q. 2021 Mar;99(1):240-272. doi: 10.1111/1468-0009.12507.
Policy Points Spending on prescription drugs is much higher per capita in the United States than in most other industrialized nations, including France. Lower prescription drug spending in France is due to different approaches to managing drug prices, volume of prescribing, and global health budgets. Linking a drug's price to value both at the launch of the drug and over its lifetime is key to controlling spending. Regulations on prescription volume and global spending complement the interventions on prices. If the United States adopted the French approach to regulating drug pricing, Medicare could potentially save billions of dollars annually on prescription drug spending.
Prescription drug spending per capita in the United States is higher than in most other industrialized countries. Policymakers seeking to lower drug spending often suggest benchmarking prices against other countries, including France, which spends half as much as the United States per capita on prescription drugs. Because differences in drug prices may result from how markets are organized in each nation, we sought to directly compare drug prices and pricing regulations between the United States and France.
For the six brand-name drugs with the highest gross expenditures in Medicare Part D in 2017, we compared the price dynamics in France and the United States between 2010 and 2018 and analyzed associations between price changes in each country and key regulatory events. We also comprehensively reviewed US and French laws and regulations related to drug pricing.
Prices for the six drugs studied were higher in the United States than in France. In 2018, if Medicare had paid French prices for the brand-name drugs in our cohort, the agency would have saved $5.1 billion. We identified 12 factors that explain why the United States spends more than France on drugs, including variations in unit prices and the volume of prescriptions, driven by use of health technology assessment and value-based pricing in France.
Key drivers of lower drug spending in France compared to the United States are that the French government regulates drug prices when products are launched and prohibits substantial price increases after launch. The regulation of prescription drugs in France is governed by rules that can inform discussions of US prescription drug policy and potential Medicare price negotiations.
目的：处方药品的人均支出在美国远高于其他大多数工业化国家，包括法国。法国的处方药品人均支出较低，是因为在药品价格管理、处方量和全球卫生预算方面采取了不同的方法。在药品推出时及其整个生命周期内将药品价格与其价值挂钩是控制支出的关键。对处方量和全球支出的监管补充了对价格的干预措施。如果美国采用法国的药品定价监管方法，医疗保险每年在处方药品支出方面可能会节省数十亿美元。
背景：美国的人均处方药支出高于大多数其他工业化国家。寻求降低药品支出的政策制定者经常建议将价格与其他国家（包括法国）进行基准比较，因为法国的人均处方药支出仅为美国的一半。由于药品价格的差异可能源于每个国家的市场组织方式不同，我们试图直接比较美国和法国的药品价格和定价法规。
方法：对于 2017 年医疗保险部分 D 中支出最高的六种品牌药品，我们比较了 2010 年至 2018 年期间法国和美国的价格动态，并分析了每个国家的价格变化与关键监管事件之间的关联。我们还全面审查了美国和法国与药品定价相关的法律和法规。
发现：在所研究的六种药品中，美国的价格高于法国。如果医疗保险在 2018 年按照我们研究队列中的品牌药品的法国价格支付，该机构将节省 51 亿美元。我们确定了 12 个因素，解释了为什么美国在药品上的支出高于法国，包括单位价格和处方量的差异，这是由法国使用卫生技术评估和基于价值的定价驱动的。
结论：与美国相比，法国药品支出较低的主要原因是法国政府在药品推出时监管药品价格，并禁止推出后大幅提价。法国的处方药监管受规则管辖，这些规则可以为美国处方药政策的讨论和潜在的医疗保险价格谈判提供信息。
