Suffolk University.
J Health Polit Policy Law. 2022 Dec 1;47(6):755-778. doi: 10.1215/03616878-10041163.
This article compares the pharmaceutical pricing policies employed by public and private insurers in the United States with seven price and spending control strategies employed in the United Kingdom, France, and Germany. Differences between American and European policies explain why American pharmaceutical prices and per capita spending are higher than in European nations. The article then analyzes two recent bills as examples of significant American reform ideas-H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act (introduced in 2019) and the Build Back Better Act (BBBA, introduced in 2021)-and compares them with European cost control strategies. Key drug price provisions of the BBBA were incorporated into the recently enacted Inflation Reduction Act (IRA). H.R. 3 would have used an international (mostly European) price index to cap U.S. prices; the BBBA would cap Medicare prices at a discount from average U.S. market prices. Neither bill would employ the key cost control strategies that European nations do. Both bills would have significantly less impact on prices than legislation that employs European-style cost controls. This article proposes steps that Congress could take in line with European strategies to lower purchase prices and costs for patients. These measures would have to overcome political obstacles that currently stymie reform.
本文比较了美国公共和私人保险公司采用的药品定价政策，以及英国、法国和德国采用的七种价格和支出控制策略。美国政策与欧洲政策之间的差异解释了为什么美国的药品价格和人均支出高于欧洲国家。然后，本文以两项最近的法案为例，分析了美国的重大改革思路—— Elijah E. Cummings 降低药品价格现在法案（2019 年提出）和重建美好未来法案（2021 年提出），并将其与欧洲的成本控制策略进行了比较。重建美好未来法案的关键药品价格条款被纳入最近颁布的《降低通胀法案》（IRA）。 Elijah E. Cummings 降低药品价格现在法案将使用国际（主要是欧洲）价格指数来限制美国的价格；重建美好未来法案将以美国市场平均价格的折扣来限制医疗保险价格。这两项法案都不会采用欧洲国家采用的关键成本控制策略。这两项法案对价格的影响都将远小于采用欧洲式成本控制的立法。本文提出了国会可以采取的措施，以符合欧洲降低患者购买价格和成本的策略。这些措施必须克服目前阻碍改革的政治障碍。
