Americans didn't always spend the most. In the 1980s, several countries spent equally, but US spending grew faster in the 1990s, according to a 2017 analysis from the Commonwealth Fund. This was partially because several expensive specialty drugs came to market, and because drug companies that set the price in the United States, unlike in Europe, which has price controls.Americans often pay substantially more for the same drug than people in other countries do.
Why prices are so high
Generic versions of these medications can lower costs, and they now make up 90% of dispensed prescriptions, according to the IQVIA Institute for Human Data Science. Typically, multiple generic options are needed for one drug before it gets cheaper, according to a study published Tuesday in the journal Health Affairs.
Patients who can't afford medications pin hopes on Trump
Patients who can't afford medications pin hopes on Trump
"I think patients are right to have serious concerns about pricing," said study author Stacie Dusetzina, an associate professor in Vanderbilt University's Department of Health Policy and Ingram associate professor of cancer research. "And in many cases, insurance benefits aren't generous if they have insurance, meaning patients often pay far too much out of pocket. In some cases, people wind up draining their savings or losing their homes."
Modern drugs are often necessary to save lives, and drug companies blame the expense on the high cost of making them and getting approval from the US Food and Drug Administration.
"That's a myth that is prevalent in the pharmaceutical industry that drugs are so expensive because companies are taking all that money and plowing it back into research and development to discover the new drugs of tomorrow. That's not really true," said Dr. Jerry Avorn, a professor of medicine at Harvard Medical School .
He co-authored a 2015 study that found that a couple dozen game-changing drugs were based on research done not by pharmaceutical companies, but by federally funded academic researchers.
"Making drugs affordable would not destroy innovation," said Avorn, who is chief of the Division of Pharmacoepidemiology and Pharmacoeconomics in the Brigham and Women's Hospital Department of Medicine.
Soaring drug prices? Here's how to control them
"Since companies set prices to whatever the market will bear, then it is not really a surprise that most companies which are for-profit want to get their shareholders the maximum price," Dusetzina said. "That's merely being a rational actor in this marketplace."
PhRMA, the pharmaceutical industry group, did not respond to a request for comment in time for publication.
The highest price tags
Plenty of patients with common health problems shudder about the costs of drugs, but the most expensive drugs typically treat rare diseases. A few cure hepatitis C, which afflicts 3.5 million Americans; those medications, though expensive, need to be taken for only a short amount of time.
There are, however, drugs that patients take for life that cost tens of thousands of dollars each month. Manufacturers offer coupons and set up nonprofits to help defray costs, but not all patients qualify for either, Dusetzina said.
Follow CNN Health on Facebook and Twitter
See the latest news and share your comments with CNN Health on Facebook and Twitter.
Duzetzina points to Revlimid, which treats blood cancer and costs about $20,000 for a 30-day supply. A patient on Medicare Part D, the program's prescription plan, pays 5% of the price, about $1,000 a month, plus a $5,000 copay.
Some drugs have hit close to the $1 million mark, including a gene therapy, Luxturna, that can restore sight to children with a rare retinal disease. Its price was set at $850,000. A drug to treat hemophilia B that's making its way through the approval process, SPK-9001, could cost $1.5 million.
GoodRx, which tracks drug prices, ranked the most expensive drugs available on an outpatient basis, based on the wholesale acquisition cost that a typical patient in a typical case would typically use in a month. That's not necessarily what you'd pay, as several steps can add expense before it gets to you, but it's an example of how expensive drugs can be.
Here are the five most expensive drugs in the United States:
1. Actimmune: $52,321.80 for one month
Actimmune is used to boost the immune system in chronic granulomatous disease. It can also slow malignant osteopetrosis, a rare bone-hardening disorder.
Chronic granulomatous disease is a rare genetic disorder that affects cells in the immune system and stops a body from fighting infections effectively. A person with this disease will typically get a serious bacterial or fungal infection every three to four years. About one in 200,000 to 250,000 people worldwide has it, according to the National Institutes of Health.
Matt Flesch, a spokesman for Horizon Pharma, the maker of Actimmune, said in a statement that the wholesale acquisition cost is "not an accurate reflection of cost," and that many variables and "complexities in coverage" can affect the price. Flesch said the average net price is $24,000 per month.
Actimmune is "used by fewer than 500 people living with two extremely rare, life-threatening diseases, and we have assistance in place so that where applicable patients are able to receive the medicine regardless of their ability to pay," Flesch said.
2. Daraprim: $45,000 for one month
Daraprim is an antiparasitic used to treat toxoplasmosis, an infection caused by one of the most common parasites in the world. More than 60 million Americans may be infected with it, according to the Centers for
Disease Control and Prevention, but people with healthy immune systems rarely have symptoms. Those with compromised immune systems and pregnant women can have serious reactions such as brain disease, blindness or miscarriage.
Maker Vyera Pharmaceuticals, formerly known as Turing Pharmaceuticals, faced questions from Congress when its former CEO raised Daraprim's price from $13.50 a pill to $750. Despite the scrutiny, the price remains high.
Curtis Jackson, a pharmaceutical investor to whom Vyera referred questions, said that it takes about a billion dollars to create a drug. Daraprim was created in 1952, he said, so the money it brings in now doesn't pay for its development but is being used to create a new version.
"Hopefully, we won't need this one in three years, when the other is approved," Jackson said. The current version is "so toxic" that a lot of doctors won't use it, he said.
Vyera donates 60% of the Daraprim that's produced and offers it at half-price to hospitals, he said. He also noted that acute treatment for patients on Daraprim usually lasts six weeks or less.
3. Cinryze: $44,140.64 for one month
Cinryze is a C1 inhibitor to prevent attacks in people with hereditary angioedema, a rare condition that occurs in one in 10,000 to one in 50,000 people. The attacks involve swelling of the skin, mucous membranes or both. They can affect a person's upper respiratory and gastrointestinal tracts and can be fatal.
Drug maker Shire PLC said in a statement, "Shire is committed to responsibly pricing our products to reflect their value and to help support patient access. If the therapy provides a meaningful impact on the lives of patients, if it fulfills that high, unmet need, value is created, and we price our products commensurate with that value. This approach also enables us to continue to invest in developing innovative therapies for patients living with rare conditions."
4. Chenodal: $42,570 for one month
Chenodal is a tablet that helps a small number of patients with gallstones for whom surgery is too risky. Gallstones can block the ducts in the gallbladder and can cause severe pain.
The drug is manufactured by Retrophin, which did not respond to a request for comment.
5. Myalept: $42,137.60 for one month
Myalept is an injectable that helps people with leptin deficiency, a rare disorder; only a few dozen cases are reported in the medical literature, according to the National Institutes of Health. Leptin is an important hormone that helps control metabolic processes. People with generalized lipodystrophy have little or no fat tissue all over the body. The drug lowers triglycerides, blood sugar and A1C levels.
It's manufactured by Aegerion Pharmaceuticals, which did not respond to a request for comment.
Correction: A previous version of this story incorrectly stated the price of Luxturna.President Donald Trump accused the pharmaceutical industry of "getting away with murder" with high price increases, and promised to do something about it. He's set to share his plan to do so Friday.
تضاعف المبلغ الذي ينفقه الأميركيون على العقاقير التي تستلزم وصفة طبية تقريبا منذ تسعينيات القرن الماضي ، حسبما توصل إليه تحقيق حكومي عام 2017 ، مما يعني أن الولايات المتحدة تنفق أكثر الدول ذات الدخل المرتفع. ارتفعت أسعار القائمة 6 ٪ خلال ال 12 شهرا الماضية وحدها ، وفقا لموقع الوصفات الطبية GoodRx. ارتفعت أسعار أدوية الرعاية الصحية 10 أضعاف معدل التضخم.
لم يكن الأميركيون يقضون معظم الوقت دائما. في الثمانينيات ، أنفقت العديد من البلدان على قدم المساواة ، ولكن الإنفاق في الولايات المتحدة نما بشكل أسرع في التسعينيات ، وفقا لتحليل عام 2017 من صندوق الكومنولث. هذا هو السبب في أن شركات الأدوية في الولايات المتحدة لا تملك نفس الدواء في الولايات المتحدة.
لماذا الأسعار عالية جدا
تتوفر إصدارات عامة من هذه الأدوية بأسعار أقل ، وتشكل 90٪ من الوصفات الطبية ، وفقًا لمعهد IQVIA لعلوم البيانات البشرية. عادة ، هناك عدة خيارات عامة مطلوبة لدواء واحد قبل أن يصبح أرخص.
المرضى الذين لا يستطيعون شراء الأدوية يعلقون الآمال على ترامب
المرضى الذين لا يستطيعون شراء الأدوية يعلقون الآمال على ترامب
واضاف "اعتقد هاستا على حق لديهم مخاوف جدية حول التسعير" وقال مؤلف الدراسة Dusetz لستاسي، وهو أستاذ مشارك في قسم جامعة فاندربيلت في السياسات الصحية وانجرام أستاذ مشارك في أبحاث السرطان. "وفي كثير من الحالات ، لا تكون مزايا التأمين سخية إذا كان لديهم تأمين ، وهذا يعني أن المرضى غالباً ما يدفعون مبالغ كبيرة جداً من الجيب.
وكثيرا ما تكون هناك حاجة إلى أدوية حديثة لإنقاذ الأرواح ، وتلقي شركات الأدوية اللوم على المصاريف المتعلقة بصنعها والحصول على موافقة إدارة الأغذية والعقاقير الأمريكية.
وقال "هذا ليس صحيحا حقا. هذا شيء جيد حقا للقيام به." جيري أفورن ، أستاذ الطب في كلية الطب بجامعة هارفارد.
شارك في تأليف دراسة في عام 2015 وجدت أن عشرات من الأدوية المتغيرة في اللعبة تم القيام بها من قبل شركات الأدوية ، ولكن من قبل الباحثين الأكاديميين الممولين اتحاديًا.
"إن صنع الأدوية بأسعار معقولة لن يدمر الابتكار" ، قال آفورن ، وهو رئيس قسم علم الأدوية والأدوية في قسم الطب.
ارتفاع أسعار المخدرات؟ إليك كيفية السيطرة عليها
وقالت دوسيتزينا: "بما أن الشركات تضع الأسعار على كل ما ستتحمله السوق ، فليس من المفاجئ أن تكون معظم الشركات راغبة في الحصول على الحد الأقصى لمساهميها". "هذا مجرد ممثل عقلاني في هذا السوق."
لم تستجب PhRMA ، وهي مجموعة الصناعات الدوائية ، لطلب التعليق.
أعلى علامات الأسعار
يعاني الكثير من المرضى من مشاكل صحية شائعة. بعض العلاجات من التهاب الكبد الوبائي سي التي تصيب 3.5 مليون أمريكي. هذه الأدوية ، على الرغم من أنها باهظة الثمن ، يجب أن تؤخذ فقط لفترة قصيرة من الزمن.
ومع ذلك ، هناك أدوية تأخذ الحياة مقابل هذه التكلفة. وقال دوسيتزينا ان المصنعين يقدمون قسائم وينشئون مؤسسات غير ربحية للمساعدة في تحمل التكاليف لكن ليس كل المرضى مؤهلين للحصول عليها.
اتبع CNN Health على Facebook و Twitter
اطلع على آخر الأخبار وشارك تعليقاتك على CNN Health على Facebook و Twitter.
يشير دزيتزينا إلى Revlimid ، الذي يعالج سرطان الدم ويكلف حوالي 20،000 دولار لإمداد لمدة 30 يومًا. يدفع المريض على Medicare Part D ، خطة البرنامج الطبية ، 5٪ من السعر ، حوالي 1000 دولار في الشهر ، بالإضافة إلى مبلغ 5000 دولار.
بعض الأدوية قد ضربت ما يقرب من 1 مليون دولار ، بما في ذلك العلاج الجيني ، Luxturna ، التي يمكن أن تعيد الأطفال إلى مرض شبكية نادر. تم تحديد سعره بمبلغ 850،000 دولار. يمكن أن يتكلف دواء لعلاج الهيموفيليا B الذي يشق طريقه خلال عملية الموافقة ، SPK-9001 ، 1.5 مليون دولار.
إن GoodRx ، التي تتعقب أسعار الأدوية ، هي واحدة من أغلى الأدوية المتاحة في العيادات الخارجية ، بناءً على تكلفة اقتناء الجملة التي عادة ما يستخدمها المريض النموذجي في شهر واحد. وهذا ليس بالضرورة ما ستدفعه ، حيث أن العديد من الخطوات يمكن أن تضيف نفقات قبل أن تصل إليك ، ولكنها مثال على مدى تكلفة الأدوية.
فيما يلي خمسة أغلى المخدرات في الولايات المتحدة:
Actimmune: $ 52،321.80 لمدة شهر واحد
يستخدم Actimmune لتعزيز جهاز المناعة في مرض حبيبي مزمن. كما يمكن أن يبطئ ترقق العظام الخبيث ، وهو اضطراب نادر يصيب العظام.
مرض حبيبي مزمن هو اضطراب وراثي نادر يؤثر على خلايا الجهاز المناعي ويوقف الجسم عن مكافحة العدوى.
